A Worrisome Shortness of Breath

A reader reaches out to Harvard Health about a worrisome shortness of breath. What could be causing it? Can it be treated?

Question:

I had a chest cold about six weeks ago. I thought I was over it within five days, but I feel like I am still more short of breath than usual. Is it from the chest cold? What else might be causing it?

Answer:

When considering what might have caused your shortness of breath, I like to consider four general categories: a lung issue, a heart problem, anemia (low red blood cell count), and deconditioning.

I suspect your “chest cold” was a case of viral bronchitis. Since the symptoms resolved within a week, deconditioning secondary to such a short illness is less likely, except if you were already more sedentary due to health issues. So, let’s put this cause aside for now.

Regarding the other three categories, knowing if you have other symptoms besides shortness of breath is also important. For example, shortness of breath, coughing and wheezing usually suggests a lung problem. Even people who have never had asthma can develop asthma-like symptoms after a viral respiratory illness. Those symptoms can last many weeks before resolving.

Shortness of breath from a heart problem could be due to a weak or stiff heart, which can diminish the heart’s pumping ability, known as cardiomyopathy. With cardiomyopathy, people also can experience ankle swelling from fluid retention and difficulty breathing when lying down. Also, most people with coronary artery disease — plaque buildup in the walls of arteries that supply blood to the heart — experience chest pain with exertion, but sometimes shortness of breath is the only symptom.

A low red blood cell count, especially anemia due to iron deficiency, would be less likely than the other causes mentioned. Besides shortness of breath, other signs of anemia are pale skin and weakness.

Since you’ve had shortness of breath for six weeks, you definitely want to arrange for medical evaluation to help determine the underlying problem. Then, your doctor will likely have enough information to suggest whether your chest cold was either a cause or contributing factor to your continuing symptoms.

Your doctor will take a detailed history of your symptoms and perform a physical exam focusing on the heart and lungs. Initial diagnostic tests will likely include wearing a finger probe to measure your blood oxygen level, a blood test to check for anemia, and chest imaging with a chest x-ray or CT scan. Additional investigation might include an echocardiogram, which uses sound waves to assess heart function, and an evaluation of your breathing (called pulmonary function tests).

The good news is that you and your doctor can formulate a treatment plan to help improve your symptoms, even if you don’t discover the specific reason for the shortness of breath.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

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