Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
10 October 2007

SHORTNESS OF BREATH – 1

            As a general overall rule, pain problems are the most common reason patients seek medical advice from a healthcare provider.  The pain can be everything from abdominal discomfort to arthritis problems, to chest pain, to headaches, etc. etc.  But a second very common reason patients come to seek medical attention is because of shortness of breath or inability to breath comfortably.  The spectrum of problems that can present as shortness of breath is about as wide as those that can cause pain. 

            The most common reason of all for anyone to become short of breath is exertion.  When a person tries to run or to work harder and faster, shortness of breath is a guarantee if the person does it long enough, hard enough.  That shortness of breath is nature’s way of telling us we are doing more than our bodies can tolerate.  It is a built in defense mechanism.  As our coaches taught us in grade school and high school, physical conditioning can improve this symptom and at heroic levels, people can run marathons.  Even marathoners become short of breath but it is not a disease state. 

            The most common reason for shortness of breath in the individual is deconditioning that comes with inactivity and age.  Clearly, physical training and exercise can improve this symptom but it takes loyalty to a long-term program to maintain this benefit.  Unfortunately, the benefit fades relatively quickly when we quit exercising. 

            But what about that situation where the shortness of breath is not due to deconditioning?  What are the diseases that cause shortness of breath?  In the recent past, I have run into unusual causes of shortness of breath.  One of these was a person who had “diabetic ketoacidosis”.  This person had uncontrolled diabetes that led to severe acid production in the body.  Excess acid in the body by itself will cause shortness of breath.  When we control the person’s diabetes, their shortness of breath improves within the day.  A second person was an individual that was simply walking down the hall of the hospital and suddenly lodged a large blood clot in his lung.  The blood clot had broken loose from his leg where it had been formed in a large vein.  The clot traveled thru the venous system until it blocked the lung circulation.  The man became horribly short of breath within two minutes and very nearly had a fatal outcome.  Fortunately, with supportive care, and the use of blood thinning medicines, this person also survived.  But these are unusual and dramatic causes of shortness of breath.  Much more common are those that have severe heart disease or severe lung disease or both.  Unfortunately, there are a large number of people with both heart and lung disease. 

            The heart disease patients are those whose hearts simply can’t pump enough blood to meet the body’s needs.  Heart disease comes in a large variety of conditions including high blood pressure, too long, too high.  Heart attacks kill part of the heart muscle leaving less muscle to do the heart’s work.  There are a host of conditions that simply damage the whole heart muscle making it weaker and unable to pump.  Any time a person has a weakened heart muscle, their ability to pump blood to meet the body’s needs is impaired.  Those with relatively minor problems become very short of breath with exertion but there are many unfortunate individuals who are short of breath at rest and this is a horrible sensation.  Fortunately, there are many useful steps to treat heart failure and alleviate the shortness of breath that occurs.  The healthcare providers at your local clinics are well versed on how to treat heart failure.

            But the thrust of this column and the next two is to address chronic lung disease.  The three leading causes of death and disease in our society are heart attack, cancer and stroke.  The mortality rate and the morbidity from these conditions are decreasing as our medical expertise improves over time.  There have been dramatic decreases in the rate of heart attack and stroke and very encouraging improvements in survival from cancers.  But chronic lung disease is increasing as a cause of morbidity and mortality.  Following World War II, 65% of the adult population in the United States smoked cigarettes.  Now that is reduced to an average of 26% in this country.  But as a stunning new statistic, 1 in 3 cigarettes in this world are smoked in China.  The epidemic of lung disease that is going to occur there will dwarf the problems that we have had.  The same problem is occurring in many other third world countries and this lung disease is going to be an increasing worldwide problem.  Already, chronic lung disease is the 4^th leading cause of death and morbidity in our country.  Fortunately a host of relatively new medications are available to help with this problem and will be described in the next column.

This and other columns available at www.macpierre.com.