Shortness of breath - the causes of

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Most lung problems of any consequence present with difficulty in breathing. However other problems may also present with shortness of breath and should always be considered in any differential diagnosis.

Shortness of breath is a symptom which arises as a result of lack of oxygen. The causes of this are:

  1. Lung disease - see Chronic obstructive airways disease
  2. Circulation problem ie - pump (heart) failure. See Heart disease - what are the symptoms
  3. Circulation problems in the lungs such as recurrent pulmonary emboli.
  4. Hyperventilation (causes an "apparent" lack of oxygen). Please see Hyperventilation - makes you feel as if you can't get your breath
  5. Anaemia.

Chronic lung disease

Because conventional medicine tends to use the same drugs to treat lung problems, doctors have become intellectually lazy and no longer differentiate between the various types of lung disease. There are three major pathologies going on in lung disease, namely:

  1. Narrowing of the breathing tubes (broncho spasm treated with blue inhalers: broncho-dilators).
  2. Chronic inflammation of the lungs treated with brown inhalers (steroids). In the early stages inflammation causes mucous production and a general clogging up of the lungs. Eventually it causes increased stiffness of the lungs so breathing becomes laboured. See Chronic obstructive airways disease (COAD).
  3. Emphysema: loss of the surface area of the lungs. In advanced stage, oxygen is very helpful. Damage to airways may be caused by free radical stress and it is always worth looking at Antioxidants.

Smoking can cause all three problems

Narrowing of the airways

This is what happens in pure asthma. The narrowing is variable and causes a variable peak flow (how fast one can exhale and easily measured with a peak flow meter: email my office - see How to contact us). Indeed the definition of asthma is a peak flow which varies by more than 15% in 24 hours. Pure asthma is always totally reversible and has a cause. The commonest causes are viral infection, allergy (to foods, bacteria, inhalants, chemicals), hyperventilation and magnesium deficiency and increasingly air pollution. Dr Dick van Steenis maintains air pollution is now more important than smoking as the major cause of asthma and COAD.

Chronic lung inflammation resulting in chronic obstructive airways disease (COAD)

Patients with pure inflammatory conditions of the lung (which is unusual, there is often other disease) theoretically would have a normal peak flow, but there is a general clogging up of lung tissue with mucous and inflammatory swelling so oxygen cannot pass freely into the blood and it is this which causes shortness of breath. Causes of lung inflammation in order of importance include:

  • Dusts such as smoking, pneumoconiosis, silicosis.
  • Pollution: small particulate matter, heavy metals, gaseous irritants such as nitrous oxide, ozone and sulphur dioxide.
  • Chronic allergy: consider inhalants (house dust mite, animal furs), foods and chemicals.
  • Infections such as bronchiectasis, chronic bronchitis and TB.

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