Attributing shortness of breath to old age is a common misconception and could be dangerous if it delays medical evaluation of this important symptom. Smoking and alcohol abuse increase the risks for conditions that cause difficulty breathing, as do the use of some over-the-counter pain medications. Treatment that addresses the reasons for shortness of breath can improve the health and comfort of seniors.
Chronic obstructive pulmonary disease, or COPD, includes chronic bronchitis and emphysema. In emphysema, aging and exposure to tobacco smoke and pollution cause the lung tissue to become inflexible, leading to the collapse of small sacs where oxygenation normally takes place. Chronic bronchitis is caused by progressive inflammation, first of the smaller bronchioles and eventually of the larger airway tubes. Increased mucus secretion and infection ultimately obstruct airflow.
According to the American Lung Association, COPD is the fourth leading cause of death in the United States 12. With early treatment, the progression of COPD can be slowed, but damage to the lungs is irreversible. The condition typically begins after 10 or more years of smoking. Initial symptoms are mild and have little impact on the quality of life. Over time, shortness of breath increasingly becomes a problem relative to moderate exertion, such as walking up hill. Gradually COPD patients have difficulty breathing while doing minor tasks. Supplemental oxygen may be required for eating and walking on level ground. Lying flat worsens shortness of breath; it may be necessary and more comfortable to sleep with the head of the bed elevated.
- Chronic obstructive pulmonary disease, or COPD, includes chronic bronchitis and emphysema.
- Over time, shortness of breath increasingly becomes a problem relative to moderate exertion, such as walking up hill.
Congestive Heart Failure
Signs & Symptoms of Relapse From Pneumonia
Most causes of heart failure are more common in elderly people. Previous heart attack, narrowed or damaged coronary arteries, high blood pressure, and weakened heart muscle due to long-term alcohol abuse are possible contributing factors. In congestive heart failure, or CHF, the heart muscle is too weak to contract sufficiently to pump oxygenated blood throughout the body 2. As blood pools in the lower extremities, fluid seeps into surrounding tissues, causing the ankles to swell. Sluggish circulation around the lungs allows fluid to seep into the airways. Shortness of breath may quickly become more severe and the need for medical care urgent.
The American Heart Association reports that heart failure interferes with the kidney's ability to remove sodium and excess fluid from the body, therefore people with CHF must restrict fluid intake and dietary salt 12. CHF may be associated with COPD; it is not unusual for elderly persons to have both conditions.
- Most causes of heart failure are more common in elderly people.
- The American Heart Association reports that heart failure interferes with the kidney's ability to remove sodium and excess fluid from the body, therefore people with CHF must restrict fluid intake and dietary salt 1.
In anemia, the body's oxygen requirements go unmet due to a lack of red blood cells. Symptoms include shortness of breath, pale skin color and fatigue. An article published in the October 2000 "American Family Physician" states that chronic disease is the most common cause of anemia in the elderly 3. The list includes infections, kidney and liver disease, inflammatory disorders or cancer. Iron deficiency, a result of poor senior nutrition or poor nutrient absorption, is the second most common cause of anemia. Gastrointestinal bleeding, a side effect of non-steroidal anti-inflammatory drugs used to treat arthritis pain, also leads to anemia.
- In anemia, the body's oxygen requirements go unmet due to a lack of red blood cells.
- Iron deficiency, a result of poor senior nutrition or poor nutrient absorption, is the second most common cause of anemia.
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- American Lung Association: COPD
- American Heart Association: Congestive Heart Failure
- "American Family Physician", Anemia in the Elderly, Smith D., October 1, 2000
- Rodríguez-roisin R, Soriano JB. Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease. Proc Am Thorac Soc. 2008;5(8):842-7. doi:10.1513/pats.200807-075TH
- Sze MA, Hogg JC, Sin DD. Bacterial microbiome of lungs in COPD. Int J Chron Obstruct Pulmon Dis. 2014;9:229-38. doi:10.2147/COPD.S38932
- Choi WI. Pneumothorax. Tuberc Respir Dis (Seoul). 2014;76(3):99–104. doi:10.4046/trd.2014.76.3.99
- Durham AL, Adcock IM. The relationship between COPD and lung cancer. Lung Cancer. 2015;90(2):121–127. doi:10.1016/j.lungcan.2015.08.017
- Cleveland Clinic. Pulmonary hypertension (PH). Updated November 21, 2019.
- Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-Important psychological comorbidities of COPD. J Thorac Dis. 2014;6(11):1615-31. doi:10.3978/j.issn.2072-1439.2014.09.28
- Kahnert K, Lucke T, Huber RM, et al. Relationship of hyperlipidemia to comorbidities and lung function in COPD: Results of the COSYCONET cohort. PLoS ONE. 2017;12(5):e0177501. doi:10.1371/journal.pone.0177501
- Lee AL, Goldstein RS. Gastroesophageal reflux disease in COPD: links and risks. Int J Chron Obstruct Pulmon Dis. 2015;10:1935-49. doi:10.2147/COPD.S77562
- Mouronte-roibás C, Leiro-fernández V, Ruano-raviña A, et al. Predictive value of a series of inflammatory markers in COPD for lung cancer diagnosis: a case-control study. Respir Res. 2019;20(1):198. doi:10.1186/s12931-019-1155-2
- Murphy J, Lau G, Agius M. An audit of the reporting of depression & anxiety in COPD patients. Psychiatr Danub. 2019;31(Suppl 3):276-281.
Mary Earhart is a registered nurse, a public health nurse and licensed midwife. Her articles have appeared in professional journals and online ezines. She holds a Bachelor of Science in nursing from California State University at Dominguez Hills. She works in a family practice clinic, has a home birth practice and her specialty is perinatal substance abuse.