Shortness of breath at night or under stress: what to do?


Shortness of breath is the sensation of difficulty breathing. This feeling can be very subjective. About the causes and therapies.

Under respiratory or dyspnea, physicians understand the subjective experience of breathing sounds of different types and intensities. It is a feeling that can not always be objectified by a doctor in an examination.

Patients describe breathlessness in very different ways – therefore, doctors even speak of a “language of breathlessness”. Common descriptions in connection with dyspnoea are:

  • “I feel that my breath is fast.”
  • “I can not exhale.”
  • “I can not breathe.”
  • “My breathing is superficial.”
  • “I have to do more breathing work.”
  • “Breathing is more exhausting.”
  • “I have a sense of suffocation.”
  • “I have a tight feeling.”
  • “My chest is tied up.”
  • “I have air hungry.”
  • “I feel breathless.”
  • “I can not get enough air.”
  • “My breath is heavy.”
  • “I have to breathe more.”

The sensation of respiratory distress sometimes arises through the interaction of several physiological, psychological, social and environmental factors. For example, it is by no means only diseases of the respiratory organs such as asthma or a displacement of the respiratory tract by foreign bodies or the like, which can lead to shortness of breath.

Differentiation of acute and chronic respiratory distress

Physicians distinguish between acute and chronic respiratory distress. Acute respiratory distress develops within minutes or a few hours. It can be a sign of a life-threatening situation. If the shortness of breath persists for more than a month, it is a chronic respiratory distress. It too should be purposefully investigated and treated.

Assessment of dyspnea by severity

Respiratory distress is assessed according to its severity. This is done on the one hand only on the basis of the individual sensation of the air distress ( Borg scale ) and on the other hand on the basis of the resilience or the activities in which there is a shortage of air ( American ATS scale ).

• Borg scale

The Borg scale measures the dyspnea experienced by the patient within the last 24 hours on a scale of 0-10 (0 = not at all, 10 = maximum respiratory distress).

• ATS scale

0 = no dyspnea : no discomfort with rapid walking in the plane or with a slight increase, except during significant physical exertion.

1 = mild respiratory distress : shortness of breath when walking fast in the plane or with a slight increase.

2 = moderate respiratory distress : shortness of breath. In the plane, the person concerned is slower than people of the same age, he needs pauses to catch his breath, even if he pursues his own pace.

3 = Severe shortness of breath : the affected person must take breaks at a walking pace after just a few minutes or at about 100 meters.

4 = Very severe respiratory distress : the person concerned is too short of breath to leave the house; he already suffers from a shortage of air when dressing and undressing.

Everybody breathes life in and out all the time, in most of the time he does not even notice or pay attention to it. But the automated process of breathing is by no means simple: certain centers in the brain stem are apparently involved in this as well as parts of the cerebrum. A large number of “signal receivers”, so-called receptors , keep the respiratory muscles under control and ensure that the gas exchange and the necessary control circuits run without interruption. Disruptions in these regulatory circuits lead to respiratory distress. The cause of such disorders can be diseases of various organs:

Common causes of acute dyspnea

Acute respiratory distress associated with heart disease:

  • Heart attack
  • Coronary heart disease (CHD): recognize symptoms and act early
  • Cardiac arrhythmia (arrhythmia): heart out of rhythm
  • Pericarditis
  • Heart failure (heart failure)
  • cardiac tamponade
  • Acute respiratory distress associated with diseases of the lungs / respiratory tract
  • Chronic obstructive pulmonary disease (COPD)
  • asthma
  • lung infection
  • pneumothorax
  • Accumulation of air next to the lungs in the so-called pleural space, so that the lungs can no longer sufficiently expand
  • pleural effusion
  • lung cancer
  • Secondary tumors (metastases) of cancer of other organs in the lung
  • Pulmonary edema (accumulation of fluid in the lungs)
  • bleeding
  • Foreign matter in the airways
  • interstitial lung diseases (thickening of the wall of the alveoli, hardening and shrinking)

Psychogenic acute respiratory distress (examples):

  • panic attack
  • Pain
  • fear
  • hyperventilation

Other causes of acute respiratory distress:

  • Anemia (anemia)
  • shock
  • Acute respiratory distress syndrome (ARDS, acute lung injury syndrome)
  • sepsis
  • allergic shock (circulatory collapse, anaphylaxis)
  • Medication side effects
  • ketoacidotic coma (diabetic diabetes mellitus)
  • Vocal cord spasm
  • Pain
  • neuromuscular disorders

Common causes of acute respiratory distress in children:

  • Foreign matter in the airways
  • bronchitis
  • lung infection
  • Throat inflammation (epiglottitis) (mostly caused by bacteria)
  • Croup cough
  • Heart muscle inflammation: symptoms, diagnosis and treatment
  • asthma

Common causes of chronic respiratory distress

Chronic dyspnoea associated with heart disease :

  • Coronary heart disease
  • Diseases of the pericardium
  • Valvular heart disease
  • Arrhythmia
  • heart failure

Chronic respiratory distress associated with lung disease :

  • COPD
  • asthma
  • lung infection
  • chronic thromboembolic events (movement of a blood vessel through a blood clot
  • pleural effusion
  • Foreign matter in the airways
  • interstitial lung diseases (thickening of the wall of the alveoli, hardening and shrinking)
  • Bronchiectasis (dilation of the bronchi)
  • Hypertension in the pulmonary circulation (pulmonary hypertension)
  • tumor diseases

Psychogenic, chronic respiratory distress (examples):

  • panic attacks
  • Pain
  • fear

Other causes of chronic respiratory distress:

  • anemia
  • overweight
  • bad fitness condition
  • chronic heartburn (reflux)
  • kidney failure
  • Liver failure (liver cirrhosis)
  • Diseases of the chest wall
  • Disorders of the upper airways (narrowing of the trachea, diseases of the larynx)
  • Medication side effects
  • high blood pressure
  • thyroid disease
  • Pain
  • neuromuscular disorders (for example amyotrophic lateral sclerosis ALS)

Causes of chronic respiratory distress in children:

  • developmental disorders
  • Cystic fibrosis: Early diagnosis and therapy increase life expectancy
  • Tracheomalacia (“softening” of the trachea)

Diagnosis of respiratory distress

First, the doctor determines whether or not an emergency is an emergency. If possible, he asks the patient or a companion and performs a physical examination . He pays attention to signs of disturbed breathing (respiratory rate, breathing depth, respiratory sounds ), to the severity of shortness of breath and to signs of lack of oxygen (paleness or blue color of the skin, cold sweat, restlessness). The doctor also listens to the lungs and the heart.

A so-called blood gas analysis , in which the blood is taken from an artery on the upper arm or thigh or a capillary at the ear, allows the assessment of how oxygen and carbon dioxide are distributed in the blood and how to the pH or the acid-base balance of blood. Further blood tests may give additional information on the cause of respiratory distress.

Typically, an ECG is performed to determine if respiratory distress is due to heart disease .

Certain lung or heart diseases can be detected using an X-ray of the lungs. Other possible tests are a computed tomography (CT) of the lungs, an ultrasound of the heart ( echocardiogram ), an ultrasound scan of the lungs ( sonography ) and a reflection of the bronchi ( bronchoscopy ).

In addition, if there are chronic respiratory distress, various pulmonary function tests can be performed – such as a provocation test in case of suspected asthma, walking test, spiroergometry.

Treatment for respiratory distress

Which acute measures to take with a dyspnoea depends on the severity. Sometimes acute life-saving measures with emergency ventilation , cardiac massage, defibrillation of the heart, lysis therapy (dissolution of blood clots) are necessary. In some cases, patients should always carry certain emergency medications with them.

As acute medical measures for the improvement of air distress in obstructive pulmonary diseases (bronchial asthma and chronic obstructive pulmonary disease) are primarily used drugs that expand the bronchi: sympathomimetics, which are given for inhalation , as tablets or syringes.

Morphine preparations are able to reduce the sensation of shortness of breath. They are therefore used for the heaviest, otherwise insufficiently treatable dyspnoea. The problem is the fact that they reduce the respiratory drive. For this reason, they are only used under medical supervision and careful consideration. Calming medications are occasionally used when very severe anxiety and excitement accompany or exacerbate the distress. Soothing and anxiolytic drugs also reduce the respiratory drive, which is why it should only be used as directed by a doctor, such as beta-sympathomimetics in asthma.

Hyperventilation: inhale and exhale in plastic bag for dyspnoea

In hyperventilation syndrome, there is usually a mental, increased inhalation and exhalation. Too much carbon dioxide is exhaled and the acid-base balance in the blood shifts to the basic range. In addition to calming it helps the most very excited and anxious patients, if you temporarily put them in a plastic baginhale and exhale. As a result, a portion of the excessively exhaled carbon dioxide is inhaled again and the shift in the acid-base balance normalizes again. The administration of calcium is not necessary because there is no absolute lack of calcium, but only the balance of charged and uncharged calcium shifts. Also, this shift is automatically reversed when the carbon dioxide level of the blood is back within the normal range.) In addition, if necessary, soothing drugs, such as diazepam can be given.

In cases of shortness of breath due to anemia, the administration of blood products (red blood cells) helps to improve the symptoms in the short term. But again, the cause of anemia (for example, iron deficiency) is to be sought and resolved.

If possible, it is necessary to treat the underlying disease of respiratory distress and thus remedy in this way the trigger of respiratory distress sustainably.

Prevent respiratory distress

A healthy lifestyle can help reduce the risk of dyspnoea. All factors are preceded by smoking, which increases the risk of developing chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD). Many underlying conditions that can lead to respiratory distress occur less frequently in a healthy lifestyle. A balanced diet, normal weight and regular exercise are therefore factors that reduce the risk of respiratory distress.