Amanda Wilde (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Amanda Wilde. Shortness of breath can be normal during heavy exercise or high heat, but persistent or unexplained breathlessness could happen from a number of other causes, and we're exploring that with Dr. Richard Fiero, pulmonologist and sleep specialist at University of Maryland Capital Region Health. Dr. Fiero, thank you so much for being here.

Richard Fiero, MD: Thank you for having me here.

Host: When a patient tells you, "I feel short of breath," what does that mean from a medical standpoint?

Richard Fiero, MD: Well, shortness of breath is a general term. The medical term is dyspnea, and it can feel different ways to different people. Some people feel short-winded or like they need to take a deep breath, or they have trouble taking a deep breath, or even that they just feel like they're breathing faster than usual.

Host: So, there can be different qualities to shortness of breath. Is there a medical difference between being tight-chested or being winded or wheezy or being unable to take a deep breath?

Richard Fiero, MD: It could be different in different people. And even in the same person, it might be different at different times. And it doesn't really tell us exactly why the person's short of breath. That's what makes it so tough for a person to know at home, for instance, you know, what's really going on. Sometimes they just need to seek medical care to be sure.

Host: Let's talk about the common reasons people do feel short of breath and whether those different reasons feel different from each other.

Richard Fiero, MD: Some diseases might cause shortness of breath and not the usual symptom you might expect. For instance, you could have shortness of breath from a blood clot in the lungs and not have chest pain or have a heart attack developing and not have chest pain, but just have shortness of breath.

At the same time, sometimes you can expect to have shortness of breath with a certain disorder and not get that symptom. Have, you know, a collapsed lung and get chest pain but no shortness of breath, for instance. So, difficult to tell, and it's not specific. Shortness of breath is not specific for any particular disease.

Host: And so, can you tell what it might be? For example, I'm thinking about anxiety and panic attacks that cause breathing symptoms. Can you tell when it might be anxiety and when it needs to get checked medically?

Richard Fiero, MD: Yeah, we hear that a lot in the office. Patients are wondering whether is it just anxiety or is it something physical going on, and how would I know? Shortness of breath from anxiety will feel exactly like shortness of breath from pneumonia or a flare-up of asthma. Sometimes there's associated symptoms that might lead you in one direction or the other. If there's coughing and fever, you might think pneumonia. If there's chest pain, heart attack. But again, you might lack those symptoms. So, it's hard to know if all you're having is shortness of breath, whether it's from anxiety or not.

Anxiety is a tough one because anyone who has a lot of shortness of breath is going to have some anxiety, and it's very anxiety-provoking. At the same time, you could just have anxiety alone and feel very short of breath. It's a hard thing. They often play off of each other. Like, someone might develop shortness of breath from asthma. It might cause anxiety, and the anxiety cause more shortness of breath, and the shortness of breath cause more anxiety. It's like a vicious cycle. So hard to know.

Sometimes I hear patients say, "Well, I'm pretty sure it was anxiety because after a while, when I relaxed, the shortness of breath went away." And that may be a good sign, but again, it's not definite because sometimes the physical problem, like the bronchospasm from asthma just went away eventually on its own, coincidentally with the anxiety going away.

So again, the only way to know for sure, seek medical care, let them do testing and find out. Not only that, it's important to remember, even if you know that a particular incident of shortness of breath was from something like anxiety, that doesn't necessarily mean the next time you're short of breath, that it's going to be the anxiety. You can't rely on that. Each time is independent of the others.

Host: So when we don't know what the causes are and we're feeling this, is there something we can do on the spot to try to regain breath, or should all shortness of breath be treated as an emergency?

Richard Fiero, MD: Certainly, one should try to calm down and relax. But certainly, if the shortness of breath continues and the patient is at all concerned, they should seek medical care. It's always hard to know at what point to call 911 or go to the emergency room. It's hard because sometimes rather mild shortness of breath might still be be caused by something that's much more serious going on, like, developing a heart attack or such.

So, always hard to know. And if there's a concern on the part of the patient, they should just seek medical care, call 911, or go to the ER. I want to make a point here. It always worries me when a patient says to me that they didn't want to go to the ER because they were afraid maybe it wasn't something important enough, or maybe it would end up being something not significant. They weren't admitted. Patients should never feel hesitant or embarrassed about going to the emergency room. You just can't know yourself at home. And so if there's a concern, you just have to go. You have to be on the safe side of things. It's much better to have gone to the emergency room and found out that it was not something very severe than to have stayed home too long and have a really bad result from that.

So, please seek medical care if you have a significant symptom. Never underplay your symptom or feel that you're being too sensitive. Take your symptoms seriously.

Host: For those who don't go to the emergency room, when they do seek help to see a primary care doctor or a pulmonologist, what should they expect? Are there tests that might help find the cause?

Richard Fiero, MD: Well, you know, if you've been having this shortness of breath for a while and it's chronic, intermittent, keeps coming back, certainly you need to get it checked out. And sometimes that means going to your primary care doctor. Sometimes you can even directly make an appointment with a pulmonologist, a lung doctor like myself. But the primary care doctor will listen to your story. They'll listen to your lungs. They might do some simple testing like a chest X-ray or a very brief breathing test. A lung doctor will again take your history and listen to your lungs and maybe do some more sophisticated testing like a chest CT or a longer breathing test called a pulmonary function test, a general screening test for different lung diseases.

Sometimes they will figure it after all that it might have been a heart issue, and they might send you to a cardiologist or even themselves order a sound test of the heart, an echocardiogram. But they'll get to the bottom of the problem, and you should certainly have it looked into if you have shortness of breath.

Host: My biggest takeaway from our conversation has been for those of us wondering, "Is this normal or should I get help?" It is not normal, and you should always seek help and try to find out what's going on.

Richard Fiero, MD: Certainly. It's just not possible to know for sure why you're short of breath, and you should just be on the safe side and seek medical attention. I think the bottom line is patients should take their symptoms seriously. Remember, we care about you. We appreciate you. Thank you for watching this.

Host: Thank you, Dr. Fiero, for clarifying so much today about shortness of breath, what is normal, what is not, and what we can do about it.

Richard Fiero, MD: Thank you.

Host: Dr. Richard Fiero is a pulmonologist and sleep specialist at University of Maryland Capital Region Health. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. Please share this on your social media. And for more great health information, visit health.umms.org.