Most common causes of acute shortness of breath

An average GP sees several people every week who suffer from sudden shortness of breath. It is a common and frightening complaint, which – in people under the age of 65 – is often caused by a respiratory infection or a panic attack. With sudden shortness of breath, a severe feeling of shortness of air arises from one moment to the next. Acute shortness of breath has nothing to do with aging or poor condition. Sudden or acute shortness of breath (dyspnea) is a very frightening and threatening feeling. Quick action is sometimes absolutely necessary and the complaint must always be taken seriously. Acute shortness of breath develops from one moment to the next or at most over the course of a few hours. This is the most important distinction from chronic shortness of breath. This form of respiratory distress develops over weeks, months or sometimes even years and becomes much less threatening because it takes habit.

Unable to take in enough air

With acute shortness of breath it takes much more effort to breathe normally. You hardly manage to take in and exhale enough air, you cannot sigh, you quickly get out of breath or you have a feeling of pressure in your chest. Some people also describe the latter as the feeling of a tight band around the chest.

In people under the age of 65, acute shortness of breath is usually caused by an infection of the lower respiratory tract (pneumonia or bronchitis), an asthma attack, COPD or a panic attack. In elderly people who have never had a panic or asthma attack before, such an attack is rarely the reason for sudden shortness of breath. A respiratory infection or heart problems, such as angina pectoris or a heart attack, are more likely. In rarer cases, a collapsed lung, pulmonary embolism or disorders of the larynx or vocal cords cause acute shortness of breath.

Sudden shortness of breath due to pneumonia or bronchitis

In pneumonia , bacteria, a virus or fungi cause the alveoli and the tissue surrounding them to become inflamed. The blisters are then filled with pus instead of oxygen. This means there is less oxygen in your blood and your body functions worse. The inflammation causes the lining of the lungs to swell and produce more mucus than normal. The mucus is also very thick and tough. We can cough up thin mucus, but with thick mucus this is very difficult. The mucus therefore accumulates in the lungs and becomes stuck. The airways narrow and breathing becomes more difficult. Sudden shortness of breath, for example during exertion, is often the result. Other symptoms of pneumonia are: being (very) ill, fever, chills, lack of appetite, coughing with mucus and chest pain. People with a weakened immune system (due to, for example, diabetes, heart failure, COPD or medicines) and people who smoke or drink a lot of alcohol are at greater risk of developing pneumonia.

If bacteria, a virus or harmful substances cause inflammation of the branches of the airways (bronchi), we call it bronchitis . Acute bronchitis is often the result of a neglected flu or bad cold. Bacteria that initially lead to tonsillitis, for example, can also work their way down at some point and cause bronchitis. However, inhaling harmful substances, such as exhaust fumes and tobacco smoke, often causes inflammation of the bronchi. With bronchitis the same thing happens as with pneumonia: the mucous membranes swell and produce thick and tough mucus. The small airways narrow, making breathing more difficult. Shortness of breath is then the result. Pain when breathing, persistent coughing with a lot (moist bronchitis) or little (dry bronchitis) mucus, rattling breathing and fever are also common complaints with bronchitis. If bronchitis persists for a long time, the inflammation can become chronic. The lungs are then increasingly damaged and some of the alveoli may even break down over time (emphysema).

Acute respiratory distress due to COPD, an asthma attack or hyperventilation

COPD (chronic obstructive pulmonary disease ) is a combination of chronic bronchitis and emphysema. The (small) airways are permanently narrowed, partly due to inflammation, swelling of the mucous membrane and the production of extra thick and tough mucus. Coughing and coughing up mucus are the most noticeable complaints. The accumulation of mucus in the lungs causes shortness of breath. Usually this shortness of breath slowly gets worse over time. However, sometimes external stimuli (tobacco smoke, cold or fog) can also cause an attack of acute respiratory distress. The continuous inflammation in the lungs often eventually leads to emphysema: permanent damage to the lung tissue and a significant decline in lung function. COPD is often the result of damage to the airways, for example due to smoking.

In asthma , the airways are also inflamed, causing the mucous membrane to swell and more mucus to be produced than normal. In addition, external stimuli (cold air, smoke, exertion, emotion) or an allergic reaction (for example to pollen, pet dander or house dust mites) cause the muscles of the small airways to cramp. This causes acute attacks of shortness of breath. The big difference with COPD is that people with asthma often have no problems between attacks. The hypersensitivity to stimuli is also usually much greater in asthmatics than in people who suffer from COPD. In addition to acute shortness of breath, asthma leads to wheezing, chest pain, coughing and sometimes excessive mucus production.

Hyperventilation is a panic disorder caused by breathing too fast or too deeply. Your body falls into an extreme state of stress due to (irreal) fear or tension, resulting in the production of extra stress hormones, such as adrenaline, and a greatly accelerated breathing and heart rate. Because this seriously disrupts the balance between the amount of oxygen and carbon dioxide in your blood, complaints such as dizziness, chest pain, palpitations, trembling, sweating and acute shortness of breath occur. Hyperventilation is often accompanied by anxiety disorders such as agoraphobia, fear of illness, fear of dying, fear of loss of control, fear of going to sleep and social anxiety.

Severe sudden shortness of breath due to a collapsed lung or pulmonary embolism

In a collapsed lung (pneumothorax), one of the lungs has completely or partially collapsed. Air has come between the membranes of the inside of the chest and the outside of the lungs, preventing the lung from expanding during inhalation. Normally, the space between the membranes of the chest and the lungs is a vacuum and the membranes move smoothly over each other with each breath. However, sometimes an injury causes an opening in the pleura or an underlying lung disease (for example COPD) spontaneously creates an opening in the pleura, allowing air to enter between the membranes. The result is chest pain and (severe) shortness of breath. The larger the part of the lung that has collapsed, the worse the symptoms are. A small collapsed lung sometimes heals on its own with rest. A large collapsed lung can be an emergency and must always be treated surgically.

If a blood clot lodges in one of the pulmonary arteries, a pulmonary embolism occurs . Blood can then no longer reach part of the lungs, causing chest pain, shortness of breath and accelerated breathing. In severe cases, blood is sometimes also coughed up. A pulmonary embolism is usually caused by thrombosis; a condition in which blood clots form in veins or arteries. Blood clotting then no longer functions normally due to poor quality of the blood vessel (arteriosclerosis), slow blood circulation (for example during prolonged bed rest) or an excessive tendency for the blood to clot. In the event of a pulmonary embolism, rapid treatment is necessary.

Acute respiratory distress due to heart problems

Angina pectoris or a heart attack often lead to sudden shortness of breath. In heart failure, which is usually caused by impaired heart pump function, shortness of breath often develops slowly.

Angina pectoris , also called heart cramps or chest pain, is caused by a narrowing of the coronary arteries of the heart. As a result, the heart does not receive enough blood. As a result, a shortage of oxygen often occurs in part of the heart muscle, especially during exertion, emotional stress, the transition from a warm to a cold environment or after a heavy meal. This leads to shortness of breath and a pressing pain behind the breastbone, which sometimes radiates to the arm (usually the left), the jaws, the back or the shoulder blades. An attack of angina pectoris usually lasts no longer than fifteen minutes and often stops when you rest or take a vasodilator medication. Men over 60 and women over 70 are at greater risk of angina. The narrowing of the blood vessels on the outside of the heart muscle (the coronary arteries) can worsen and eventually lead to a heart attack. Angina pectoris is therefore a serious condition.

During a heart attack or myocardial infarction, one of the coronary arteries of the heart is completely blocked by a blood clot. This means that part of the heart muscle does not receive any blood or oxygen at all. The acute pain and shortness of breath are comparable to those of angina pectoris, but the complaints are worse, last longer and do not disappear with rest. Also, the medications you may use for angina pectoris do not work in the event of a heart attack. The part of the heart muscle that no longer receives oxygen can no longer contract properly and dies. A scar is formed at this location, which can lead to permanent damage to the heart. The lasting consequences of the myocardial infarction depend on the size and location of the infarction. Smoking, high blood pressure, high cholesterol, obesity, diabetes, long-term stress and hereditary predisposition increase the risk of a heart attack. If you suspect a heart attack, you should always call your GP or hospital immediately.

Sudden shortness of breath due to a disorder of the larynx or vocal cords

The narrowest part of the airway contains the larynx and vocal cords. If the airway becomes even narrower at that location due to a disorder of the larynx or vocal cords, shortness of breath can easily develop. An inflammation of the larynx, the valve of the larynx or the vocal cords can lead to difficulty breathing due to swelling of the mucous membrane. In addition, complaints such as hoarseness, loss of voice, sore throat, swallowing problems and fever may occur. Such inflammation is usually caused by a bacterial or viral infection. A wasp or bee sting in this narrow part of the airway can also cause severe sudden shortness of breath.

In most cases, sudden shortness of breath is caused by one of the above conditions. Very occasionally, an allergic reaction (for example angioedema), a rare condition of the lungs (for example an abnormality of the alveoli or high blood pressure specifically in the blood vessels of the lungs), (malignant) tumors (for example lung cancer), problems with the nervous system, chest abnormalities or anemia to acute shortness of breath.

Sudden or acute shortness of breath is very frightening and threatening for most people. The shortness of breath develops from one moment to the next or at most over the course of a few hours. Sometimes quick action is absolutely necessary. Acute shortness of breath must therefore always be taken seriously.