Harvard Heart Letter

Coping with shortness of breath

New guidelines suggest treatments for the shortness of breath that can accompany advanced heart failure.

One of the most distressing complications of advanced heart failure is the feeling that you can't get enough air. This shortness of breath — dyspnea (DISp-knee-uh) in medicalese — has been defined in the cool language of clinicians as "a subjective experience of breathing discomfort" and "an uncomfortable sensation or awareness of breathing." People who have chronic shortness of breath describe it as suffocating, smothering, and hungering for air.

Chronic shortness of breath affects millions of people. It also commonly accompanies conditions such as chronic obstructive pulmonary disease (COPD), lung cancer, stroke, muscular dystrophy, and others. Yet it has received relatively little attention. "Only in the past 10 years has there been general recognition of just how distressing dyspnea can be," says Virginia Carrieri-Kohlman, a professor of nursing at the University of California, San Francisco, who has been studying shortness of breath since the early 1980s. In fact, the field is roughly where the field of chronic pain was in the 1980s, before clinicians and researchers began a dedicated push to better understand pain, improve treatments for it, and ease needless suffering.

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