Getting to the Cause of Shortness of Breath

by Andrew Getzin, MD

Shortness of breath with exercise is a common but perplexing problem for both patients and doctors. Apparently fit athletes often struggle trying to figure out why they have problems with exercise that would seem to be well within their capabilities. There are a number of possible causes for shortness of breath, which makes this a very challenging diagnosis. Doctors don’t always get it right.

The most common cause for shortness of breath is asthma. Exercise is a trigger for 90% of asthmatics. In addition, non-asthmatics can often have an asthmatic-like response to exercise called exercise-induced bronchospasm (EIB). Physicians often assume that when a patient complains of shortness of breath the cause is asthma, and they appropriately treat the problem with asthma medications.  While this treatment can be effective for some EIB patients, others are left wondering why they are not getting relief.

What are the other common causes of shortness of breath?

The most common causes, in addition to asthma, are lack of fitness, vocal cord dysfunction, anemia, and pulmonary or cardiac problems. The key to successfully helping patients with shortness of breath is to obtain objective data that lead to an accurate diagnosis and appropriate treatment. 

What is the recommended diagnostic approach?

In the Department of Sports Medicine and Athletic Performance at Cayuga Medical Center, we offer a special multidisciplinary clinic to assess people who are troubled by shortness of breath. Our multi-specialty team is made up of Rob Strominger, MD (otolaryngology), Frank Micale, MA (exercise physiology), a respiratory therapist, and Andrew Getzin, MD (sports medicine). The key to appropriate treatment is establishing a good assessment of the actual problem. We offer our patients a maximum exercise treadmill test to assess their cardiac rhythm and obtain their maximum oxygen uptake, the gold standard for cardiovascular fitness assessment. We couple this test with pre- and post-test spirometry to assess for asthma and with direct visualization of the patient’s vocal cords via a flexible fiber optic tube to look for abnormal vocal cord closure. When indicated, we perform blood work to rule out anemia and can obtain a chest x-ray to look for potential pulmonary problems.

What happens once the data are gathered?

With the information we are able to collect, we can confirm an accurate diagnosis and determine appropriate treatment. Depending on the specific problem, we may recommend medications for asthma or anemia, speech therapy to address vocal cord dysfunction, an exercise plan to develop a higher level of fitness, or treatment for cardiac or pulmonary pathology that is revealed during the testing.

We are very fortunate in Tompkins County to be able to collaborate with experienced health-care professionals from several different disciplines, working with a team approach to treat shortness of breath in athletes. We are helping people of all ages from around the upstate New York region achieve better performance in their chosen activities. The Shortness of Breath in Athletes Clinic is held once a month at Cayuga Medical Center Sports Medicine, located in the Island Health Center. You can make an appointment by calling (607) 252-3580.

Dr. Getzin is clinical director of Cayuga Medical Center Sports Medicine and Athletic Performance and is a member of the medical staff at Cayuga Medical Center. He is board certified in sports medicine, is a member of the American Society of Sports Medicine, and serves as head team physician at Ithaca College and TC3. He is also a competitive triathlete, earning All-American status with USA Triathlon.

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