Why Are You Short of Breath? What a Respiratory Therapist Needs to Know
Last updated: December 2022
I work in a hospital as a respiratory therapist. I take care of anyone who is short of breath. If you come to the hospital experiencing severe shortness of breath, it is my job, along with that of the doctors and nurses, to get you feeling better. To best treat you, we have to first know why you are short of breath.
There are basically five things that may cause you to become short of breath:
- Asthma. This is treated with rescue medicine and steroids.
- COPD. This is treated with rescue medicine and steroids, and sometimes BiPAP.
- Pneumonia. This is treated with antibiotics and other medicines as needed.
- Heart failure. This is treated with diuretics and other heart medicines.
- Other. These causes include cystic fibrosis, bronchiectasis, kidney failure, etc.
So, why are you short of breath?
As you can see, what is causing your symptom often determines the course of treatment. If we know you have asthma, we can treat you with asthma medicine. If we know you have COPD, we can treat you with COPD treatments. This is why it is important for us to know your history – but sometimes we do not know. So, what do we do then? How do we treat you?
We often have to make educated guesses. This is important, as we want to start treatment as soon as possible. We don’t want you to have to wait for test results to come back, as that can take some time.
If we don’t know why you are short of breath, it’s possible to treat you for multiple conditions. The doctor may tell me to give you a breathing treatment, while the nurse starts you on diuretics, antibiotics, and steroids.
Interestingly, asthma, COPD, pneumonia, and heart failure can all cause bronchospasm. This is when your air passages become narrow and obstructed, which may cause shortness of breath. Bronchospasm is treated with the asthma medicine albuterol. I can give you this medicine as soon as you walk into the ER. It is given via a nebulizer breathing treatment, and it usually works pretty quickly. If this is what is causing your symptoms, great! We fixed you up fast.
But, say you are experiencing pneumonia, or heart failure. How do we know? I may listen to your lung sounds. This can help me “guess” if you are experiencing pneumonia or heart failure. I have personally been working in an ER for 25 years, so I am pretty good at guessing. I imagine many of my fellow nurses and doctors are the same way.
What if you have COPD? A COPD flare-up can be caused by the COPD itself, but it can also be caused by pneumonia. It may also be caused by heart failure. So again, we may treat you for all these conditions, and this will probably begin with a breathing treatment.
Are your lungs filled with fluid? Do you have foot and ankle edema? Do you have trouble breathing while lying on your back? Do you need to be sitting up tall to breathe? Are your oxygen levels low? Have you gained weight recently? These are all signs you may be retaining fluid. These are all things we can check for quickly. They are also signs you have heart failure and should be treated for that.
So, if a doctor doesn’t know why you are short of breath, a breathing treatment will usually be ordered right away. And then, if heart failure is suspected, the doctor will likely order a diuretic to make you pee, such as Lasix or Bumex. This medicine usually takes a while to take effect. In the meantime, other efforts will be used to help you breathe easier. More breathing treatments are always an option.
This is where my BiPAP machines come in handy. (I've previously written about how BiPAP can help with heart failure flare-ups.) A mask will be placed over your mouth and nose. The machine offers soft pressures to help you breathe easier. These devices work great for taking the edge off of the feeling of shortness of breath. Once the medicine takes effect, your breathing gets better and we can take you off the machine.
We can help you breathe easier
As I described here, we use our skills to make an educated guess about your condition. Sometimes we don't know, but we don't waste any time starting treatment. Labs will be drawn and a chest X-ray and other tests will probably get ordered. The ER doctor will eventually determine what is causing your shortness of breath, and at that point, the treatment will be adjusted accordingly.
We can usually reverse shortness of breath. We can get you feeling better. Sometimes we can get you feeling better fast, and sometimes it takes a little longer. But, we can get you breathing easier. This is one of the joys of my job: using my skills and knowledge to help people feel better.
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