Defining the causes for breathlessness, or troubled breathing, illustrates how perplexing it can be making the right diagnosis when someone has a medical problem.
It was a party night while I was in college when someone’s date was rushed into my dorm room gasping and breathing rapidly, asking if I could help her. Someone must have known that I had asthma when younger and that I might be able to help this desperate young woman. She seemed extremely anxious and I remember trying to reassure her unsuccessfully. I think she eventually had to go to the local emergency room and everything eventually turned out OK.
Years later in medical school, during a lecture on lung conditions, I remembered the young lady with the rapid breathing experience years earlier and realized that she likely had breathlessness from anxiety and hyperventilation, and not from asthma, or any other respiratory illness. Since then I have seen hyperventilation syndrome occur in many more people, mostly while I was working the ER.
It is important to realize this condition is a real deal. Anxiety-driven over-breathing causes the body’s pH balance to go way out of whack, resulting in numbness and even severe spasticity of the extremities, which in turn makes the patient even more frightened. One common treatment is to have the person rebreathe into a paper bag to normalize the acid-base or pH balance of the blood. I prefer having the patient go for a brisk walk, which reassures the patient they are not so sick, and works as well in returning the blood pH to normal.
Most of the other causes for dyspnea, or shortness of breath, are not so easy to fix. The following list, which is not complete, illustrates how diverse and varied the causes for breathlessness can be: obstructive lung disease like asthma, chronic bronchitis, and emphysema; infections like viral influenza or bacterial pneumonia; excessive fluid and swelling within the lung like congestive heart failure or lung edema from lung infection; too much acid in the blood like diabetes out of control or with certain kinds of poisoning; and lung wall lining irritation like viral pleuritis or embolic blood clots to the lung. In addition, think how anxiety and hyperventilation might make all these problems seem worse.
So when you run into someone who is having trouble breathing, the one thing you know for sure is that it could be from many causes: maybe just a little anxiety, maybe something really bad, or maybe both. Bottom line, when breathless, always seek help.