Dear Dr. Roach: A recent column discussed shortness of breath on exercise. My aunt had this exact same scenario, and it turned out to be lung cancer. She ignored it for a while, then when she got checked out, it was too late — she had stage 4 lung cancer. Please tell this person to see an oncologist. I write this with a heavy heart and tears. I miss my aunt.
I am very sorry about your aunt.
Shortness of breath is a common concern, and it has many, many causes. However, the vast majority of them, if they will ever be diagnosed at all, will be due to a heart or lung problem, low blood count or anxiety disorder.
There are a number of heart problems that can cause shortness of breath. The term “dyspnea,” Greek for “bad breathing,” is used medically. Heart failure and blockages in the arteries are the most common. Heart problems are often the first to be considered, as it may be the symptoms of an impending heart attack.
Similarly, there are different lung issues that can cause trouble breathing. Asthma, chronic obstructive lung disease — that is, emphysema and chronic bronchitis — and the many forms of interstitial lung disease, such as pulmonary fibrosis, all are common.
Low blood count (anemia) from any cause can trigger difficulty breathing, especially with exercise.
Anxiety disorders, particularly panic attack, can cause recurrent episodes of difficulty breathing associated with severe anxiety. Physicians need to be meticulous to do a thorough evaluation of possible causes, even in someone with clear anxiety, before ascribing symptoms to psychological causes. It's possible the anxiety is due to, or worsened by, the shortness of breath from heart or lung problems, for example.
Initial testing for a person with new onset of significant trouble breathing usually includes an EKG, chest X-ray, oxygen level and blood count. Further testing depends on other symptoms or risk factor a person may have and the results of the initial testing.
Lung cancer, unfortunately, usually does not have many worrisome symptoms until it is advanced.
Cough and weight loss occur more often than shortness of breath does. Even so, a physician needs to be concerned about lung cancer, especially in people with risk factors, but recalling that some, especially older women, may get lung cancer with no history of smoking.
Oncologists are generally consulted when the diagnosis of cancer is made.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu