What mental illness causes shortness of breath?

Shortness of Breath: What’s Normal?

Ever feel as though you can’t catch your breath? That heavy, can’t-quite-get-enough-air feeling that leaves you wondering if you overdid it or if something is wrong? Pulmonologist Sandeep Gupta, MD, UnityPoint Health, clarifies what’s normal and what’s not for shortness of breath, including when it’s time to be seen by a doctor.

What Does Shortness of Breath Feel Like?

Shortness of breath, or dyspnea, is difficulty breathing when resting or performing every day, age-appropriate tasks. Shortness of breath is commonly associated with symptoms of fatigue and anxiety, as well as a possible cough and/or chest pain.

“Shortness of breath can be sudden, or it can present slowly over time,” Dr. Gupta says. “Sudden shortness of breath may be caused by a secondary infection in the already compromised lung from lung disease. Slow, onset shortness of breath usually occurs if someone is a long-standing smoker, which also leads to lung disease.”

Shallow breathing is not the same as shortness of breath. Shallow breathing isn’t considered dyspnea if the person is comfortable performing daily tasks.

“Technically, shallow breathing means shorter inhaling and exhaling than normal breathing but with an equal cadence. While in shortness of breath, inhalation is usually much shorter than exhalation,” Dr. Gupta says.

Shallow breathing can become shortness of breath when normal tasks are no longer possible, or if feelings of anxiousness start to occur.

What Causes Shortness of Breath

Many conditions can be associated with shortness of breath. Dr. Gupta lists the most common.

Asthma. Reversible inflammation and constriction in the airway (bronchi) that makes both inhaling and exhaling difficult.
Chronic obstructive pulmonary disorder (COPD). Irreversible condition marked by slow changes in the breathing tubes (bronchi and alveoli) that makes exhalation difficult.
Heart attack. Causes either decreased blood flow to the lungs or congestion of the lungs with fluid.
Interstitial lung disease. Damage in the lung tissue from various long-term causes, like smoking, job environment, etc.

“Typically, people start to feel short of breath in their 50s, as changes take time to progress. When we’re young, we can make up for reduced lung function with our physical state,” Dr. Gupta says.

If someone experiences shortness of breath at a young age, Dr. Gupta says it’s most commonly from asthma or acute bronchitis. In certain cases, like emphysema or early onset cardiac diseases, genetics may play a role.

How to Tell if Shortness of Breath is from Anxiety

Shortness of breath is a common symptom of anxiety. This is a normal reaction by the body.

“If people notice shortness of breath while feeling anxious, they should try to find the cause of the anxiety, get out of the situation and calm themselves down. Symptoms can progress to a panic attack. So, if things don’t improve, it’s best to seek urgent medical attention,” Dr. Gupta says.

Shortness of Breath from COVID-19

Shortness of breath is also one of the symptoms experienced by those who contract the COVID-19 virus. Dr. Gupta says your experience with this symptom could vary depending on the severity of the viral infection.

“Shortness of breath can be mild to very severe. The symptoms could start with a mild cough and shortness of breath with exertion and exercise, and then it progresses to be shortness of breath while at rest,” Dr. Gupta says.

Shortness of breath with COVID-19 begins because of the viral inflammation in the body, which damages the lungs. That can cause pneumonitis and pneumonia. Dr. Gupta says, unfortunately, the virus can worsen quickly causing hospitalization.

If you’re experiencing shortness of breath from COVID-19, contact your care team to determine the best approach for your care.

Shortness of Breath with Exercise

If you’re just finishing a hard workout, feeling short of breath isn’t unusual. But, if you feel like you have regular shortness of breath with exercise, Dr. Gupta suggests keeping this in mind.

“An important factor when working out is the overall conditioning shape of the body. Slowly building in intensity during your workouts should help with feeling less winded,” Dr. Gupta says.

However, there are some shortness of breath symptoms that aren’t normally associated with exercise and shouldn’t be ignored. See a doctor if you experience any of the following:

High heart rate with chest heaviness
Chest pain, pressure or palpitations
Paleness
Dizziness or sinking sensation
Fatigue
Fainting

Shortness of Breath Treatment

If shortness of breath is an isolated event, Dr. Gupta says you can try these methods to feel better at home:

If associated with a cough or congestion, try using steam or over-the-counter decongestants to relieve feeling short of breath.
If wheezing, use an inhaler with your provider’s approval.

“If shortness of breath continues for a couple of hours, doesn’t get better or comes back, it’s always safest to seek medical attention,” Dr. Gupta says.

Every person is different, and treatment options differ with disease causes. Having an accurate diagnosis by a pulmonary specialist is key to fully managing shortness of breath.

“Consult your doctor as soon as possible to get a diagnosis and treatment plan. The sooner the diagnosis, the simpler the treatment can be. Waiting too long can make the disease progress and get more complex,” Dr. Gupta says.

I feel like I can’t breathe!

It’s scary to feel like you can’t breathe. Breathing is one of the most essential activities for life, and most people take it for granted. But there are many health conditions—both physical and mental—that can make it difficult to breathe. Understanding why you’re having trouble breathing can help you feel safer, more in control, and empowered to take action.

Even if your trouble breathing is due to anxiety, it’s still a scary experience. Anxiety and panic attacks aren’t immediately life-threatening in the same way as, say, a heart attack. But they are still valid medical concerns that need to be addressed in their own way. In fact, trouble breathing due to anxiety is so common that it’s a good place to start before jumping to conclusions about your physical health.

Trouble breathing and anxiety

Anxiety is a type of fear. When you are afraid, your body goes into “fight or flight” mode [1]. Your body is designed to deal with dangers like being attacked by a wild animal or having to run away from falling rocks. Your body isn’t always smart enough to realize that you can’t deal with all your day-to-day struggles by running away or fighting for your life. A lot of the time, that “fight or flight” mode only makes things worse. Shallow breathing and tense muscles just make you feel even more afraid.

That’s why anxiety causes trouble breathing. So what’s the solution? Well, there are many ways to treat anxiety. But here are a few quick things that are helpful for many people:

Relaxation techniques, like deep breathing or meditation.
Getting some physical activity. This provides an outlet for stress and also increases your lung capacity over time. Yoga is especially helpful for becoming more aware of your breath.
Writing down your anxious thoughts in a journal.
Talking to a trusted friend or family member about how you’re feeling.
Distracting yourself with things you love doing, whether it’s playing a musical instrument or watching something lighthearted on TV.
Talking to a therapist.
If you’ve tried many of these things and nothing seems to be working, you can ask a doctor about medication for an anxiety disorder.

You can do many of these things on your own. Start with those, and see if you feel any better. If your anxiety doesn’t go away or it comes back later, then start to think about getting help from someone else.

Your body gets ready for a life-or-death situation. In those situations, it’s helpful to have tense muscles and fast breathing so that you can run away from danger. Your body isn’t always smart enough to realize that the thing you’re afraid of isn’t something you can escape by running away or fighting.

“COVID anxiety” and other respiratory illness

When the COVID-19 pandemic first hit, many of us suddenly became more aware than ever of our breathing. Any trouble breathing could be a sign of COVID. Of course, people are still getting COVID, and for people who have already had it, “long COVID” can be scary as well. So for many of us, the same heightened awareness of our breathing is still with us.

Ironically, anxiety about COVID can also make it difficult to breathe. This makes it hard to know whether you’re having trouble breathing because you’re sick, or because you’re afraid of getting sick!

You can start by thinking about your other symptoms. Although anxiety and a virus can both lead to trouble breathing, there are some differences [2]:

If you have a fever or a cough, that’s a good sign that you may be sick. Don’t just go by how you feel, because anxiety can also make you feel hot and sweaty. Take your temperature with a thermometer. If you don’t have one, have someone else feel your forehead.
If you suddenly have trouble breathing and it goes away after 20 minutes or so, that’s more likely to be an anxiety attack. Even if this happens over and over, if you can breathe okay in between, that’s a good sign. A virus is more likely to make it hard to breathe for hours or days at a time.

If you’re worried about COVID-19, follow CDC guidelines to prevent getting sick and avoid spreading the virus to others.

Although COVID-19 is still the main virus on most people’s minds, many of the same things apply to other respiratory illnesses, like colds or the flu.

Other medical concerns

People who suddenly have trouble breathing often feel like they might be having a heart attack. This is really scary because it feels so urgent—you feel like you’re going to die, and you don’t have much time to react. Here’s an article on the differences between a panic attack and a heart attack. Understanding how a panic attack feels different from a heart attack can help you feel less afraid, and more in control of the situation.

There are also lots of other, less urgent, physical causes of trouble breathing. This article can help you go through some of the possibilities. You can also take our online anxiety test to see if anxiety might be the problem.

If you feel like you have other symptoms, it’s worth looking into possible physical health concerns. But also keep in mind that while the Internet can be a great source of information… It’s also easy to convince yourself that you have something more serious than you really do.

Caporuscio. (2019). What’s the link between anxiety and shortness of breath? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/326831
Jones. (2020). Shortness of breath: Anxiety or coronavirus? The Scope, University of Utah Health. Retrieved from https://healthcare.utah.edu/the-scope/shows.php?shows=0_0s956sjk

‘Long Covid’: Are You Feeling the Symptoms?

Fatigue, brain fog, difficulty breathing, chest pain, and other health issues. These are the symptoms 20 million U.S. adults diagnosed with COVID-19 are still having three months after first contracting the virus, according to new federal data.

Overall, 1 in 13 adults in the U.S. (7.5 percent) have symptoms of “long COVID”—as the condition is known—that they didn’t have before their COVID infection, according to a survey conducted by the U.S. Census Bureau. The data was analyzed by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS).

Long COVID symptoms

People with long COVID have a range of new or continuing symptoms that can last weeks or months after they are infected with COVID. The condition typically worsens with physical or mental activity.

Dr. Ravi Ramaswami, a family medicine physician with Lee Health, says long COVID can affect anyone who has COVID — old and young, otherwise healthy people, and those battling other conditions.

“People with long COVID can have a wide range of symptoms which can last more than four weeks or even months after infection,” says Dr. Ramaswami. “In some cases, symptoms can disappear, only to come back again.”

Long COVID doesn’t affect everyone the same way, according to the CDC. People with long COVID symptoms may have various symptoms that could come from other health problems. This can make it difficult for healthcare providers to identify long COVID symptoms.

“Most people with COVID get better within a few days to a few weeks after infection. Anyone who was infected can have long COVID,” notes Dr. Ramaswami, who adds many of his patients are experiencing long COVID symptoms.

“Some people with long COVID recall not noticing any symptoms when they were first infected, while others with long COVID report experiencing symptoms immediately. Then, for some people, long COVID conditions may last months, potentially years, after COVID illness.”

Long COVID symptoms can include:

Tiredness or fatigue
Difficulty thinking or concentrating (sometimes called “brain fog”)
Shortness of breath or difficulty breathing
Headache
Dizziness on standing
Fast-beating or pounding heart (known as heart palpitations)
Chest pain
Cough
Joint or muscle pain
Depression or anxiety
Fever
Loss of taste or smell

Dr. Ramaswami says many of his patients who have had COVID also report experiencing neurological issues like brain fog a month after contracting the virus.

“Everything is cloudy and muddled up in their heads. They may have sleep issues. They may feel drowsy and fatigued,” he says. “Many cases of brain fog can be linked to low serotonin or serotonin imbalance. Researchers are still studying that particular aspect.”

He’s also treated patients who self-report psychological symptoms from long COVID, such as bouts of depression, anxiety, panic attacks, and posttraumatic stress disorder (PTSD). Dr. Ramaswami tries to educate his patients about long COVID symptoms.

For patients with brain fog and long COVID depression, he’s had varying success with prescribing them anti-depressant medications. “Most patients learn to adapt, or the symptoms go away with time, eventually,” he adds.

Researchers continue to study why some people get long COVID. According to the NCHS survey, older adults are less likely to have long COVID than younger adults. Nearly three times as many adults ages 50-59 currently have long COVID than those age 80 and older.

Women are more likely than men to have long COVID (9.4 percent vs. 5.5 percent).

Other survey findings include:

Nearly 9 percent of Hispanic adults currently have long COVID, higher than non-Hispanic White (7.5 percent) and Black (6.8 percent) adults and over twice the percentage of non-Hispanic Asian adults (3.7 percent).
Bisexual adults and transgender adults (7.5 percent) were more likely to have current long COVID symptoms than adults of other sexual orientations and gender identities. Twelve percent of bisexual adults have current long COVID symptoms, compared to 7 percent of straight and gay and lesbian adults. An estimated 15 percent of transgender adults have current long COVID symptoms, compared to 5 percent of cisgender male adults and 9 percent of cisgender female adults.
The prevalence of current long COVID symptoms differed between states. The states with the highest percentage of adults who currently have long COVID symptoms were Kentucky (12.7 percent), Alabama (12.1 percent), and Tennessee and South Dakota (11.6 percent). The states with the lowest percentage of adults who currently have long COVID symptoms were Hawaii (4.5 percent), Maryland (4.7 percent) and Virginia (5.1 percent).

Source: CDC/National Center for Health Statistics

Preventing long COVID

Dr. Ramaswami says the best way to prevent long COVID is to protect yourself and others from becoming infected.

“For eligible people, getting vaccinated and staying up to date with vaccines against COVID-19 can help prevent COVID-19 infection and protect against severe illness,” he says. “Research suggests that people who are vaccinated but experience a breakthrough infection are less likely to report long COVID symptoms, compared to people who are unvaccinated.”

Talk to your doctor if you think you have long COVID.

Federal resources for people with symptoms of long COVID

The Office for Civil Rights of the Department of Health and Human Services (HHS) has this page on civil rights and COVID.

The Civil Rights Division of the Department of Justice has this page on its ADA.gov website that discusses topics related to COVID and the ADA.

CDC’s website has this page on long COVID conditions, which discusses long COVID.

The Administration for Community Living’s document, “How ACL’s Disability and Aging Networks Can Help People with Long COVID,” provides information on resources and programs to assist people with long COVID. This document is available here.

Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 1557 is available here.