Breathing problems Definition

Breathing problems are coughing, wheezing, and shortness of breath that may occur as a result of a disease, damage to the lungs, or from natural changes to the lungs as people age.

Description

The lungs serve an important function in the body. They take oxygen out of the air that's breathed

and exchange it for carbon dioxide in the blood. Sometimes, a person feels that he or she is not getting enough air. The chest feels tight, or coughing causes pain and discomfort. Mucus or sputum may be felt in the lungs or coughed up. Feeling short of breath may get worse with physical activity or with lying flat. Sometimes, shortness of breath gets bad enough that it keeps a senior from performing regular daily activities such as bathing or preparing simple meals.

As people age, the lungs stiffen and become less elastic and the airways shrink. Along with other changes, these natural changes of aging make it more difficult for as much air to flow in and out of the lungs as when people were younger. But breathing that becomes so difficult that it interferes with regular activity, causes pain, or is accompanied by regular coughing, may be a sign of a more serious problem than normal aging changes. Breathing problems may be a sign of chronic obstructive pulmonary disease (COPD), asthma, pneumonia, heart disease , obstructive sleep apnea, or other pulmonary diseases.

Demographics

More than 16 million people in the United States each year are affected by COPD. The highest rates of chronic bronchitis were among those age 65 and older. After age 65, as many as 53 per 1,000 people may have chronic bronchitis. About 3.8 million Americans are diagnosed with emphysema and 91% of them are age 45 and older. Smoking is the single highest risk factor for COPD. Asthma affects about 10% of adults over age 65. Breathing problems related to sleep (sleep apnea) also are common in seniors.

Causes and symptoms

There are many possible causes of breathing problems. Gradual changes to breathing that develop over time are most likely attributed to normal aging, COPD, or some combination. There are two main conditions that cause COPD: chronic bronchitis and emphysema. Cigarette smoking generally causes COPD, although there are other causes. Asthma usually is a long-term illness that a senior knows he or she has, but certain irritants, such as allergens, may make asthma attacks occur. Pulmonary fibrosis causes scars in the lungs, usually in people at least age 40-60 who have experienced chronic injury to the lungs.

Some breathing problems are life threatening. Pulmonary thromboembolism is the sudden blockage of air flow when a blood clot from somewhere else in the blood system, such as the leg, moves into the lungs. In aspiration , liquid or other material makes its way into the windpipe and can irritate the air passages. It also can cause infection, such as aspiration pneumonia. Shortness of breath and coughing may indicate pneumonia. At times, shortness of breath also may be caused by heart problems, not by lung problems. Leaky heart valves or heart muscles don't get enough blood or heart failure can cause fluid to collect in the lungs. Lung cancer also can cause breathing problems. Anxiety and panic attacks also can cause rapid breathing and shortness of breath.

Symptoms of breathing problems may vary depending on the underlying cause. For example, asthma symptoms include shortness of breath, fast heartbeat, cough, a tight feeling in the chest, wheezing, and others. But asthma symptoms tend to come and go, while the breathing problems from COPD may not seem as severe at first, but will not go away. They worsen over time. The most common symptoms of breathing problems are constant coughing, breathing that is difficult or labored, and wheezing. A senior may feel that he or she has to stop, rest and catch a breath before continuing activities that once were easier to complete. Many seniors ignore these symptoms, assuming they are from a cold or flu, or from simply getting older. But if coughing is severe or frequent, there is wheezing, or shortness of breath is severe and doesn't get better with rest, there may be a serious problem. Shortness of breath that does not improve should be checked by a physician. It is important to keep track of information such as when symptoms began, how long they have lasted, and what may have happened just before the breathing problem began to help aid the physician in diagnosis.

Diagnosis

Diagnosis of breathing problems is based on a careful medical history, physical examination, and possibly the use of tests. A physician will ask questions about the breathing problems and the patient's medical history, as well as lifestyle questions. For example, cigarette smoking or exposure to other possible irritants will be important to consider when determining the cause of the breathing problem. The physician also may review medications.

Diagnostic tests may include laboratory analysis of sputum if the patient is coughing up sputum. The physician also might order an electrocardiogram (EKG) to check for heart damage. Breathing tests, called pulmonary function tests, can measure how well the lungs bring air in and force air out. These tests can help determine problems with the airways and the lungs to diagnose problems such as asthma, COPD, pulmonary fibrosis, or other breathing condition.

QUESTIONS TO ASK YOUR DOCTOR

• How can I improve my breathing throughout the day?
• What sorts of signs or symptoms should I watch for that indicate a more serious problem?
• What is causing my breathing problem?

Blood tests may measure the amount of oxygen and carbon dioxide in the blood to see if the lungs are functioning properly or to determine possible causes of breathing problems.

Bronchoscopy may be used to try and determine why an airway is blocked. The bronchoscope is a long, narrow, flexible instrument that is passed through the patient's mouth or nose, allowing the physician to look into the airways. A chest x-ray may be one of the first tests ordered to have a look at the lungs. However, a computed tomography (CT) scan of the chest can show more detail, particularly if the physician suspects a blood clot (pulmonary thromboembolism) or certain types of cancer . Other imaging and heart tests also may be ordered. Sometimes, tests must be repeated before a cause is diagnosed.

Treatment

Treatment for breathing problems depends on the cause of the problem. If diagnosis reveals COPD, for instance, the physician may order a combination of treatments and therapies that aim to improve the patient's breathing and delay progress of the disease. Depending on severity, pneumonia may be treated with antibiotics and steroids. Seniors with severe pneumonia may require a hospital stay. Obstructive sleep apnea can be corrected with a method that applies continuous airway pressure while sleeping, as well as other treatments and therapies. Some breathing problems will require use of certain medications and bronchodilators , which provide medicines through measureddose inhalers that can open up the airways and improve breathing temporarily. Pulmonary embolisms are treated with anticoagulants, which thin the blood. A senior may have to remain on oral blood thinners for a period of time to prevent a clot from occurring again.

If breathing problems become severe, such as with COPD or pulmonary fibrosis, seniors may require oxygen therapy some or all of the time. Most breathing problems can be improved by quitting smoking and avoiding other possible irritants. Often, physicians or other providers such as respiratory therapists also may work with seniors to improve their fitness and help them learn to breathe more efficiently.

Nutrition/Dietetic concerns

People with breathing problems may have more trouble breathing if they eat large meals because the stomach pushes on the diaphragm, the muscle that helps in breathing. Seniors need to eat well-balanced diets because good nutrition helps fight infection. Seniors who have COPD or another breathing problem that produces sputum are encouraged to drink extra fluids to keep mucus thin and easier to cough up. Some have heart conditions that require less fluid. If a patient has a cannula through which oxygen is provided, it should be left in place while eating.

Seniors who have difficulty swallowing should take care when eating to prevent aspiration, which could lead to aspiration pneumonia.

Therapy

Many seniors with breathing problems will have pulmonary rehabilitation , a program that includes exercise instruction and counseling to help patients stay more active and able to perform daily activities. Physicians, nurses, physical therapists, dietitians, and respiratory therapists may help with this therapy.

Prognosis

Prognosis depends on the underlying cause of breathing problems. COPD cannot be cured or reversed, but the worsening of breathing symptoms can be delayed by quitting smoking and following other advice and therapies. Some diseases, such as lung cancer, carry a poor prognosis. The prognosis for some conditions, such as pneumonia, varies depending on the senior's overall health and other factors. Pneumonia can be fatal in some cases and managed effectively in others. Seniors can reverse the effects of many breathing problems. Breathing problems from asthma or anxiety can be easily managed and have good outcomes.

Prevention

Many breathing problems such as COPD can be prevented by avoiding smoking cigarettes or quitting cigarette smoking. Other breathing problems may be prevented by taking steps to prevent the underlying cause. For example, being overweight is one risk factor for obstructive sleep apnea, as well as for many heart diseases. Being out of shape and gaining weight rapidly can directly lead to shortness of breath. Following a carefully prescribed exercise program may prevent shortness of breath.

KEY TERMS

Bronchitis —Inflammation of the airway tubes.

Pulmonary —Related to or carried on by the lungs.

Sputum —The matter that is discharged from the lungs when they are diseased. It usually contains mucus and may contain other substances such as blood or pus.

Wheezing —Difficult breathing because of attempts to force air through narrow airways; usually accompanied by a whistling sound.

Caregiver concerns

Care givers should pay careful attention to changes in breathing problems in those they care for. If breathing problems become severe, particularly suddenly, there may be an immediate need for medical attention. Often, breathing problems are ignored by seniors, but an attentive caregiver can watch for signs that breathing problems have worsened over time. Care givers also may need to help with therapies, such as light exercise or prescribed exercises to improve breathing techniques or chewing and swallowing techniques to decrease chance of aspiration. With some breathing problems, such as COPD, breathing may become so difficult that a senior needs help with regular daily activities.

Resources

BOOKS

Reilly, John J., Edwin K. Silverman, and Steven D. Shapiro. 2005. Chronic Obstructive Pulmonary Disease. In Harrison's Internal Medicine. New York: The McGraw-Hill Companies.

PERIODICALS

Asthma. CareNotes. (December 12, 2005).

OTHER

Breathing Problems: Shortness of Breath. http://www.familydoctor.org/online/famdoccen/home/articles/835.html American Academy of Family Physicians, 2006.

ORGANIZATIONS

American College of Chest Physicians., 3300 Dundee Road, Northbrook, IL, 60062, (847)498-1400, (847)498-5460, http://www.chestnet.org.

American Lung Association, 61 Broadway, 6th Floor., New York, NY, 10006, (800)548-8252, (212) 315-8700, www.lungusa.org.

National Heart, Lung, and Blood Institute, P.O. Box 30105, Bethesda, MD, 20824-0105, (301)592-8573, (240)629-3246, nhlbiinfo@nhlbi.nih.gov, www.nhlbi.nih.gov.

Teresa G. Odle