Shortness of Breath

Reviewed by: HU Medical Review Board | Last reviewed: July 2015.

Shortness of breath is a common symptom of chronic obstructive pulmonary disease (COPD). Both chronic bronchitis and emphysema can cause shortness of breath. The symptom is also called “breathlessness” or “dyspnea.”1,2

People with COPD have damage to their lungs that makes it harder to breathe. They often feel short of breath because it takes more effort to make air travel in and out of the lungs. This feeling of breathlessness is also described as:

  • More effort needed to breathe
  • Feeling of heaviness in the chest
  • Hunger for air
  • Gasping for air

This feeling of breathlessness can be very uncomfortable. It can also make a person feel anxious and frightened. However, it is important to know that when shortness of breath happens, trying to breathe through it is not actually causing any more damage.

What causes shortness of breath in COPD?

Shortness of breath is one of the main symptoms of both emphysema and chronic bronchitis. Most people with COPD have symptoms of both of those conditions, so shortness of breath is common.1

Emphysema can cause a feeling of breathlessness in different ways. It is a disease that affects the millions of tiny air sacs within the lungs. People with COPD develop emphysema due to damage to their lungs from breathing in irritants, such as cigarette smoke.

In healthy lungs, these air sacs have walls that are flexible and stretchy. To breathe in air, a muscle called the diaphragm uses energy to inflate the tiny sacs with air, like a balloon. To breathe out, the muscle relaxes and the tiny sacs bounce back to their smaller size and push the air out of the lungs without any effort needed.

Emphysema is caused by two kinds of damage to these air sacs in the lungs:

  • The walls of the air sacs lose their natural stretchiness
  • The walls that separate the air sacs from each other are destroyed

The first kind of damage means that instead of needing effort only to breathe in, people with emphysema need to use effort to breathe in and breathe out. This means they have to use twice as much effort to breathe as people with healthy lungs. This can cause a feeling of breathlessness.

When the walls between the tiny air sacs are destroyed, they combine into a smaller number of larger sacs. The new larger air sacs make it harder for the lungs to empty completely of air. In other words, “old” air from the last breath gets trapped inside the sacs. This keeps the sacs from filling up with fresh air during the next breath. People with emphysema can feel short of breath because they have too much extra air in their lungs.

Chronic bronchitis can cause breathlessness in other ways for people with COPD. This is because people with chronic bronchitis have airways that are partly blocked by:

  • Irritation that causes swelling and inflammation
  • Excess mucus produced by the lungs

Together, the swelling and excess mucus cause the airways to become narrower. Because the airways are blocked, it keeps enough air from flowing through them as it should. This can make a person feel short of breath.

Can increased shortness of breath be a sign of a COPD flare-up?

Many people with COPD have shortness of breath due to emphysema or chronic bronchitis. In fact, breathlessness that does not go away is one of the most common symptoms of COPD.1

For people with COPD, having more shortness of breath than usual can be a sign of an acute exacerbation or COPD flare-up. Shortness of breath can also be a symptom of a respiratory illness, such as:

  • Respiratory infection (acute bronchitis)
  • Pneumonia
  • Flu

What is the treatment for shortness of breath from COPD?

Shortness of breath caused by COPD can be treated and managed in several ways. First of all, taking any prescribed COPD medicines regularly - and in the right way - is very important. Taking part in a pulmonary rehabilitation program can help a person with COPD learn how to control their breathing in helpful ways.1,3

Shortness of breath can make a person with COPD tend to avoid physical activities or exercise that make the feeling of breathlessness happen. However, this habit can cause the person to become out of shape and even less able to exercise or be active. Being out of shape can then cause even more shortness of breath. For this reason, it is important for people with COPD to stay as active as possible, even if it makes them feel breathless. A regular exercise routine can help improve a COPD patient’s strength and help reduce the feeling of breathlessness.

For some patients in the later stages of COPD, oxygen therapy can help decrease shortness of breath.

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