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House Calls Started This Year

House calls are meant for patients who are temporarily or permanently home bound, or for other good reasons can't make it into the office.

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Wednesday, February 17, 2010

Short of Breath?

What is shortness of breath?

For most people "shortness of breath" or "having breathing difficulties" means a sensation of difficult or uncomfortable breathing, or a feeling of not getting enough air. Medically, this is referred to as dyspnea.

Does shortness of breath mean illness?

Shortness of breath can occur in both health and disease, and its significance varies accordingly. For example, when it occurs in a healthy person walking 100 feet at the top of a very high mountain, it may signify no disease. But if the same person had smoked a pack of cigarettes a day for 20 years, the same symptoms at lower altitude may be the first sign of progressive emphysema. In healthy individuals, shortness of breath may also occur at rest for no apparent physical reason.

Shortness of breath may be appropriate or inappropriate, real or perceived; and therefore, there is no standard lay person definition of shortness of breath. Physicians use the term dyspnea to describe "an abnormally uncomfortable awareness of breathing."

What causes dyspnea?

The issue of dyspnea comes up frequently when patients are seen in their physician's office for specific complaints, or for a periodic physical examination. It's the physician's task, not always an easy one, to determine whether the dyspnea is medically important, and to recommend a diagnostic plan and a course of therapy when needed.

Dyspnea can be acute, intermittent, or chronic, and can be caused by a heart or lung problem or physical de-conditioning; or it can be of psychogenic origin.

Common heart diseases causing dyspnea include coronary artery disease (the major cause of heart attacks), congestive heart failure, and conditions where heart valves malfunction. Lung problems include bronchial asthma, acute and chronic bronchitis, emphysema, and interstitial lung disease (diffuse scarring and stiffening of lung tissue). Exposure to allergens may precipitate an asthma attack, or dyspnea-producing post nasal drip; but the biggest undiagnosed culprit remains smoking.

Psychogenic dyspnea, precipitated by anxiety, panic or an irregular breathing pattern of frequent sighs ("sigh dyspnea"), is now diagnosed in increasing frequency. This is usually not dangerous, but it may be uncomfortable, and particularly hard to diagnose and treat.

Lack of conditioning is also a cause of dyspnea, especially seen in the "weekend warrior athlete." If you are short of breath playing basketball on Sunday afternoon, do you have a disease causing dyspnea, or is this lack of conditioning?

How is the diagnosis made?

Your account of the intensity, severity and frequency of dyspnea is very important.
This, combined with a physical examination and some basic testing, may rapidly establish the correct diagnosis.

Sometimes the diagnosis is elusive. Both asthma and heart disease can be "silent." Even lack of conditioning may be difficult to diagnose without meticulous testing. The diagnosis of psychogenic dyspnea, can be made on the basis of your symptoms, after medical causes of dyspnea have been ruled out.

For exercise-related dyspnea, we use cardio-pulmonary stress testing (CPST). This important, noninvasive test combines the familiar cardiac test with lung function testing during exercise (on a treadmill or exercise bicycle). With it, we can determine your level of cardiopulmonary fitness, and whether your shortness of breath is due to a heart problem, lung problem, de-conditioning, or "none of the above."


Treatment of dyspnea, and its effectiveness, depends on the underlying cause. Frequently, medications are used, such as those needed to optimally control asthma, congestive heart disease and anxiety. Special lifestyle instructions may be given, such as smoking cessation and allergen avoidance. Reconditioning exercises and stress management may be advised, or you may be instructed in the proper performance of diaphragmatic breathing.

Working together with your physician, in the overwhelming majority of cases, shortness of breath can be controlled or completely resolved.

Most, if not all the tools necessary to establish the cause of dyspnea and treat dyspnea are available under one roof at our practice.

Twitter / Dr. Staw