Shortness of Breath
"When you can't breathe, nothing else matters." American Lung Association
When people begin to experience shortness of breath or dyspnea on exertion (DOE), they either find ways to modify the activities that cause them discomfort, or they simply avoid them altogether. While this may seem like the safest and most reasonable course of action, decreasing your activity will actually worsen the situation, causing you to become weaker and weaker over time, until even life’s simplest tasks, like showering or getting dressed, can become difficult thanks to that miserable SOB (shortness of breath).
Let’s use stair climbing as an example. In New York City, subway steps are definitely not built for comfort. Rather, they are designed for efficiency, which in New York City means “space-saving.” As a result, they are usually longer, higher, and steeper than the stairs in most people’s homes or even those you might encounter in a restaurant or movie theater. Add to this scenario, a mob of type-A New Yorkers during rush hour, and the situation more closely resembles the running of the bulls than a daily commute. Patients frequently tell me that they don’t take the subway anymore because they can no longer climb the stairs. Instead, they take the bus or taxi, or Access-A-Ride, (but that’s a whole ‘nother story, altogether).
Again, using our stair-climbing example, think about how much less activity a person will get if they switch from taking the subway to taking the bus. Let’s say they usually commute to work five days per week and have two flights of stairs going to work and two flights coming back home. That’s 20 flights of stairs per week—80 flights per month— and nearly 1000 flights per year.
It isn’t hard to imagine that if you climb 1000 fewer flights of stairs this year than you did last year, your body will naturally (or more accurately, unnaturally), become less conditioned, and you will likely experience an increase in your shortness of breath. Incidentally, these negative adaptations to inactivity can happen even if you don’t have a pulmonary disease.
Now, here is a concept that is very important to understand. The inability to climb stairs can be affected by many factors including shortness of breath, cardiovascular disease, muscle weakness or fatigue. It can even be caused by anxiety, which, incidentally, is both increased by shortness of breath and increases shortness of breath (another vicious cycle we want to break).
As you become more deconditioned, your body does not use oxygen as efficiently. As a result, you then start to feel short of breath at lower levels of activity. Then, you start to avoid those (even lower level) activities, and so on and so forth. Again, this is called the dyspnea cycle or dyspnea spiral and as I mentioned earlier, our goal is to help you break that cycle by teaching you more effective breathing techniques—and teaching you how to exercise most effectively every time, so that your body becomes more efficient at using oxygen and you, less short of breath.
For many people, their symptoms can get so bad that the activity doesn’t seem possible or worth the effort anymore. Depending upon where you live and the resources available to you, this scenario can drastically limit the things you can do, the places you can go, and the people you can see.
Some people can map out their city by where there are steep (or in some cases, not so steep) inclines or hills. Others can map out the city based on where there are places to sit down and rest, and still others, by the availability of public restrooms. They take the easier routes whenever possible and avoid hills like the plague. But as you might have guessed, all of the muscles that they use to walk uphill become deconditioned, and they now start to feel short of breath at even lower levels of activity (e.g. walking on flat surfaces). Sound familiar?
There is also another important possibility that you (and your doctor) should consider. Believe it or not, it is completely possible that your shortness of breath could be the result of something else altogether. Patients come to us all the time that can’t understand why they’re shorter of breath. “Nothing has changed,” they protest. That’s when we start our interrogation. We inquire knowingly as to whether there have been any changes in their medications, exercise regimen, weight, and etcetera, etcetera.
“Oh, yeah. I have gained a little weight,” they say. To which I say: “How much?
“About 25 pounds,” they say (or 30, or 40, or more). To which I say: “So, you’ve gained 25 pounds and think nothing’s changed?”
Let’s put this in perspective: 25 pounds is the equivalent of two bowling balls. Try carrying two bowling balls around with you all day, every day, for a while. I am pretty sure that you will get tired more easily, have more difficulty climbing stairs, and yes; feel shorter of breath.
Patients often report feeling shorter of breath, despite no significant worsening of their lung function on Pulmonary Function Test (PFT). Conversely, patients may report an improvement in their symptoms, without a corresponding improvement in their PFT. What this tells us is that there absolutely, positively have to be other factors besides pulmonary function that affect how well or how poorly we breathe.
Our goal is to help patients break this “dyspnea cycle” by teaching them more effective breathing techniques and by exercising them most effectively (i.e. vigorously), so that their bodies get better at using oxygen. We also educate patients about their disease, medications, the benefits of exercise and eating healthy, managing stress and anxiety, and the pitfalls of cigarette smoking and inactivity. In the overwhelming majority of cases, an educated patient will be a healthier (and happier) patient.
Please feel free to share this information with your healthcare team and please be sure to get your doctor’s go-ahead before beginning any exercise program or implementing any lifestyle change.
Finally, your attitude is essential. We understand that when you feel sick, it can be difficult to focus on being shiny, happy, and positive. However, constantly focusing on your illness or all the things you can’t do can have a profoundly negative impact on your health and wellbeing.
Throughout these pages, we will be guiding you and sharing methods that will help you work your way back to wellness, so that your actions and thoughts can begin to have a profoundly positive impact on your health and wellbeing—in other words, your life. Don’t worry about the starting line. For now, think of yourself as the healthiest you can be today…and then get ready to become even healthier.
