Shortness of Breath — Definition

This is most commonly abbreviated โ€œSOBโ€ in medical charts, one reason we may not want patients to view their charts without explanation.ย  SOB is a serious symptom, due to a problem with the heart, lungs, the upper airway (rarely), or circulation. Some can be fatal.ย  However, Iโ€™ve seen many patients say they feel โ€œshort of breath,โ€ but I donโ€™t consider them to have what I call โ€œtrueโ€ SOB.

The term “true” is my invention, not used by clinicians in general.  But I use it here, because some people who feel short of breath really have no problem getting enough oxygen.  Maybe their nose is all stuffed up (but their body would make them mouth-breathe when necessary).  A bad coughing spell can leave us gasping a while afterwards, but nobody dies from that (though people can die from the asthma or pneumonia thatโ€™s causing the cough).  Stomach acid reflux can feel the same way.  Sometimes people need to pause & take a deep sighing breath; that feels โ€œSOB,โ€ but heart, lungs, & brain are doing fine.

Anxiety, in particular if there’s also hyperventilation, can create an ongoing sensation of shortness of breath.  We diagnose this if the SOB is especially felt at rest, & doesnโ€™t get worse with exertion (like walking a few blocks, or climbing stairs).  Hyperventilation sometimes causes tingling in hands & lips.  โ€œTrue SOB,โ€ that prevents our body from getting enough oxygen, always feels worse with exertion.  Imagine a tornado approaching — you might hyperventilate or panic, but youโ€™d sure dash to the shelter.  If youโ€™re in heart failure, you ainโ€™t gonna make it.

Normal Deconditioning (plain old out-of-shape) also gets worse with exertion.  If I, myself, try to run a mile, Iโ€™ll be quite short of breath, but the reason will be obvious, & I wonโ€™t seek medical care.  But sometimes a person finds themselves in a new setting, with new exertional necessities they didnโ€™t think of.  Maybe they have to walk up new flights of stairs, for example.  Still, if a patient complains of โ€œSOB,โ€ Deconditioning is a diagnosis of exclusion, meaning we have to rule out all actual illnesses first.

Brief note for Spanish speakers — in Central America at least, maybe Mexico & elsewhere, the word โ€œcansadoโ€ may be used interchangibly for โ€œSOB,โ€ โ€œfatiguedโ€ (worn out), and โ€œsleepy.โ€  Itโ€™s real important to distinguish, since these symptoms have completely different causes.

See our topic on the diagnosis of Shortness of Breath.

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