Can anxiety really cause shortness of breath?

Yes, anxiety and panic attacks commonly cause breathlessness and hyperventilation. The breathing difficulty feels very real and frightening, even though oxygen levels are normal. However, don't assume breathlessness is "just anxiety" without medical evaluation to rule out physical causes first.

Why do I get short of breath when lying down?

Shortness of breath when lying flat (orthopnea) is often a sign of heart failure, where fluid backs up into the lungs when you're horizontal. It can also occur with severe COPD or obesity. If you need to prop yourself up on pillows to breathe or wake up gasping, see a doctor promptly.

When should I go to the emergency room for shortness of breath?

Go to the ER or call 911 for sudden, severe shortness of breath; chest pain with breathing difficulty; inability to speak in full sentences; blue lips or fingernails; confusion; coughing up blood; or severe wheezing. Also seek emergency care if you have asthma or COPD and your usual treatments aren't working.

Shortness of Breath: Causes from Asthma to Heart Problems

At-a-Glance

Shortness of breath (dyspnea) can range from mild breathlessness to severe respiratory distress
Common causes include asthma, anxiety, deconditioning, COPD, and heart problems
Sudden severe shortness of breath is a medical emergency
Chronic breathlessness that worsens over time needs medical evaluation

What It Feels Like

Shortness of breath is the uncomfortable sensation of not getting enough air or difficulty breathing.

Common experiences:

Feeling like you can't get enough air
Chest tightness or heaviness
Rapid, shallow breathing
Inability to take a deep breath
Breathing requires conscious effort
Feeling winded after minimal exertion
Need to sit up to breathe comfortably

Common Causes

Asthma

Causes airway inflammation and narrowing, leading to breathing difficulty, wheezing, and coughing.

Signs: Wheezing, chest tightness, coughing (especially at night), triggered by exercise/cold air/allergens, symptoms come and go

What helps: Quick-relief inhalers (albuterol), controller medications (inhaled corticosteroids), identify and avoid triggers, allergy management

Anxiety and Panic Attacks

Anxiety can cause hyperventilation and breathlessness, even though oxygen levels are normal.

Signs: Rapid breathing, chest tightness, tingling in hands/around mouth, dizziness, sense of impending doom, triggered by stress

What helps: Slow controlled breathing techniques, cognitive behavioral therapy, relaxation techniques, anti-anxiety medications if needed

Deconditioning (Poor Physical Fitness)

Lack of regular exercise leads to reduced cardiovascular fitness, causing breathlessness with minimal exertion.

Signs: Shortness of breath only with exertion, sedentary lifestyle, symptoms improve as fitness improves

What helps: Gradual increase in physical activity, start with low-impact exercise (walking, swimming), aim for 150 minutes moderate activity weekly

COPD (Chronic Obstructive Pulmonary Disease)

Includes chronic bronchitis and emphysema, causing progressive airflow limitation. Smoking is the primary cause.

Signs: Progressive breathlessness over years, chronic cough with/without mucus, wheezing, smoking history, frequent respiratory infections

What helps: Quit smoking (most important), bronchodilator inhalers, inhaled corticosteroids, pulmonary rehabilitation, oxygen therapy if needed

Heart Failure

When the heart can't pump effectively, fluid backs up into the lungs, causing shortness of breath.

Signs: Breathlessness with exertion or lying flat, need to prop up on pillows, waking gasping for air, swelling in legs/ankles, fatigue, rapid weight gain

What helps: Medications (diuretics, ACE inhibitors, beta-blockers), sodium and fluid restriction, regular exercise as tolerated

Pneumonia

Lung infection causes inflammation and fluid accumulation, impairing oxygen exchange.

Signs: Breathlessness with fever, cough with mucus, chest pain when breathing/coughing, fatigue, chills

What helps: Antibiotics for bacterial pneumonia, rest and fluids, fever reducers, oxygen if needed, hospitalization for severe cases

Pulmonary Embolism (Blood Clot in Lung)

A blood clot traveling to the lungs is a life-threatening emergency.

Warning signs: Sudden onset breathlessness, sharp chest pain (worse with deep breathing), rapid heart rate, coughing up blood, lightheadedness, recent surgery/long flight

Action: Call 911 immediately. This is a medical emergency.

Anemia

Severe anemia reduces blood's oxygen-carrying capacity, causing breathlessness with exertion.

Signs: Breathlessness with exertion, fatigue, pale skin, rapid heartbeat, dizziness

What helps: Identify and treat underlying cause, iron/B12/folate supplementation, dietary improvements

When to See a Doctor

Call 911 Immediately If You Experience:

Severe, sudden shortness of breath
Chest pain or pressure with breathing difficulty
Coughing up blood
Blue lips or fingernails (cyanosis)
Confusion or altered mental status
Inability to speak in full sentences
Severe wheezing or stridor
Swelling of face, lips, or tongue

Schedule appointment if:

Shortness of breath worsening over time
Breathless with minimal exertion
Breathing difficulty interferes with daily activities
Other symptoms (cough, fever, swelling, fatigue)
Wake up gasping for air
Need to sleep propped up on pillows

Treatment and Management

Treatment depends on the underlying cause:

For Asthma: Quick-relief and controller inhalers, avoid triggers, allergy management

For COPD: Bronchodilators, inhaled steroids, quit smoking, pulmonary rehabilitation, oxygen

For Heart Failure: Diuretics, ACE inhibitors, beta-blockers, sodium/fluid restriction, cardiac rehabilitation

For Anxiety: Breathing techniques, cognitive behavioral therapy, relaxation strategies, medications if appropriate

General Strategies:

Pursed-lip breathing (breathe in through nose, out through pursed lips)
Diaphragmatic breathing (belly breathing)
Sit upright or lean forward slightly
Pace activities, take frequent breaks
Quit smoking
Maintain healthy weight
Regular exercise as tolerated

Frequently Asked Questions

The Bottom Line

Shortness of breath has many possible causes, ranging from benign (deconditioning, mild anxiety) to life-threatening (heart attack, pulmonary embolism). Recognizing when breathlessness requires immediate attention is crucial.

Sudden, severe shortness of breath, especially with chest pain, is always a medical emergency. Chronic, progressive breathlessness warrants medical evaluation to identify treatable causes like asthma, COPD, or heart failure.

Many causes respond well to treatment. Asthma can be controlled with inhalers, heart failure managed with medications, anxiety treated with therapy and breathing techniques, and deconditioning improved with exercise.

Don't ignore worsening breathlessness or assume it's "just getting older." Early diagnosis and treatment can significantly improve quality of life and, in some cases, be lifesaving.

Remember: This information is educational and doesn't replace professional medical advice. If you're experiencing persistent or severe shortness of breath, consult a healthcare provider for proper evaluation and treatment.