Shortness of breath is one of the most common symptoms of pulmonary arterial hypertension (PAH). If you have shortness of breath from this lung disease, you may feel like you’re not getting enough air or that you can’t catch your breath. “My oxygen is at 98 percent, but I still get short of breath and it’s hard to breathe,” said a myPHteam member.

Feeling short of breath can deeply affect your quality of life and your ability to take care of yourself. “The shortness of breath and fatigue are disabling,” shared a member of myPHteam who was diagnosed with pulmonary hypertension.

In this article, we’ll discuss how shortness of breath develops when you have PAH and how treatments can help.

What Causes Shortness of Breath in Pulmonary Arterial Hypertension?

Learning why shortness of breath happens with PAH can help you understand how treatments may work.

Does Pulmonary Hypertension Cause Shortness of Breath?

PAH is a type of pulmonary hypertension that affects the pulmonary arteries (arteries in the lungs). Pulmonary arteries are the blood vessels that carry oxygen-poor blood from your heart to your lungs. In PAH, the pulmonary arteries become too thick and narrow, slowing blood flow. This makes it harder for blood to flow between the heart and the lungs. As a result, pressure builds up in the lungs.

High blood pressure in the lungs makes the right side of the heart work harder to pump blood through the narrowed arteries. Over time, this extra work can lead to heart failure.

When the pulmonary arteries get too thick and narrow, it becomes harder for blood to reach your lungs and pick up oxygen. This means your body gets less oxygen-rich blood.

Other symptoms of PAH may include:

• Dizziness
• Tiredness
• Swelling
• Chest pain
• Cough
• Blue, gray, or discolored lips and fingers

When Does Shortness of Breath Happen in PAH?

It’s normal to become short of breath when you’re exercising or at high altitudes, but if you have PAH, you may get breathless even during normal daily activities. In the early stages of PAH, you may notice only mild shortness of breath when exercising or climbing stairs.

A member of myPHteam said, “I’m running so short of breath after riding the stationary bike for 30 minutes.”

What Does Shortness of Breath Feel Like With PAH?

As PAH gets worse, you may start feeling short of breath during activities that didn’t cause this symptom before. “I have severe PAH. Just walking across a room gets me out of breath,” one member said. Another replied, “Shortness of breath on exertion is very common every day.”

“Shortness of breath on exertion is very common every day.”

— A myPHteam member

You may feel other symptoms along with shortness of breath. One myPHteam member posted, “I’m having a really rough day. I have extreme dizziness, chest pressure, joint pain, and shortness of breath. I’m also lightheaded. Here we go again.”

How Does PAH Treatment Help Shortness of Breath?

If you or someone you love has PAH, it’s important to learn how to treat shortness of breath so you can discuss the different options with your doctor.

PAH treatments usually work by opening up the pulmonary arteries. This helps lower the blood pressure in your lungs and takes some strain off your heart.

Treatments for PAH can help slow disease progression and improve shortness of breath and other symptoms. You and your healthcare provider will develop a treatment plan based on how severe your symptoms are, other medical conditions you may have, and more.

Oral Treatments

Oral treatments come as pills you swallow. Oral treatments help treat PAH by widening the blood vessels in the lungs or preventing them from getting narrower.

Endothelin Receptor Antagonists

Endothelin receptor antagonists are medications that prevent blood vessels from narrowing. They work by blocking endothelin, a substance that makes blood vessels constrict.

Endothelin receptor antagonists can help people feel less short of breath during physical activity.

Phosphodiesterase Inhibitors

Phosphodiesterase 5 (PDE5) inhibitors help your lungs and pulmonary blood vessels respond better to vasodilators (substances that help open up blood vessels). These medications can help widen your pulmonary arteries and allow more oxygen-poor blood to flow to your lungs and more oxygen-rich blood to flow to the rest of your body.

PDE5 inhibitors have been shown to improve the ability to exercise.

Other Oral Treatments

Other oral treatments for PAH work by relaxing the blood vessels in your lungs so that your heart can pump blood to your lungs more easily. Two other established classes of oral medicine include:

• Soluble guanylate cyclase (sGC) stimulators, which work on the nitric oxide pathway
• Oral prostacyclin IP-receptor agonists, which work on the prostacyclin pathway

These oral medication classes are supported by clinical guidelines to help slow disease progression, reduce symptoms, and improve your ability to exercise.

Inhaled Treatments

Inhaled treatments are medications you inhale using a special device that delivers the medicine straight to your lungs.

Inhaled treatments for PAH are lab-made versions of prostacyclins — substances your body makes to help open blood vessels. Inhaled medications help widen your pulmonary arteries and reduce the strain on your heart.

Using an inhaled treatment may help you be more physically active.

Intravenous and Subcutaneous Treatments

Intravenous (IV) and subcutaneous treatments are injected into your body. IV treatments go into a vein, while subcutaneous treatments go just under your skin. These medications may help you exercise more easily and reduce symptoms like shortness of breath and fatigue (extreme tiredness that doesn’t improve with rest).

One newer subcutaneous treatment given every few weeks for PAH is in the class of drugs called activin signaling inhibitors. These medicines have been found to be helpful in reducing symptoms and improving exercise capacity in people with PAH.

Finding the right treatment can take time, so try to be patient with the process. Your healthcare provider may recommend pulmonary tests (lung function tests) for shortness of breath to check how well your lungs are working and determine which medications or therapies might help. Lung function tests are simple and safe. Some treatment strategies use a combination of two or more medication types.

How Do Supportive Treatments Help Shortness of Breath?

Supportive treatments can help relieve your symptoms, but they don’t treat the underlying cause of PAH.

Medications

Medications called calcium channel blockers can help lower the blood pressure in both your lungs and the rest of your body. However, they only work for a small group of people with PAH.

Other supportive medications may also be used. For example, blood thinners can help prevent blood clots, and diuretics (water pills) can reduce swelling. These treatments may help treat or prevent problems caused by PAH, but they don’t usually improve shortness of breath.

Oxygen Therapy

If your blood oxygen levels are low, your healthcare provider may prescribe oxygen therapy. This supportive therapy may be helpful for some people with PAH. Supplemental oxygen can help you feel less breathless, be more active, and continue your daily activities.

Supplemental oxygen can help you feel less breathless when your blood oxygen levels are low.

Pulmonary Rehabilitation

Pulmonary rehabilitation is a program that teaches you how to exercise with less shortness of breath. These classes often include education about PAH, supervised exercise, breathing techniques, nutrition tips, and emotional support. Ask your healthcare provider if pulmonary rehabilitation could help improve your shortness of breath from PAH.

Pulmonary rehabilitation classes include education about PAH, supervised exercises, breathing techniques, nutrition tips, and emotional support.

Lifestyle Changes

Several lifestyle changes may help improve shortness of breath from PAH. These include:

• Quitting smoking if you smoke
• Eating a balanced, healthy diet
• Staying physically active
• Avoiding high altitudes
• Staying out of hot and humid places, like hot tubs or saunas

One myPHteam member recommended staying indoors in hot, humid weather to help with shortness of breath. They shared, “I’m a little short of breath today. The temperature is 98 degrees and very humid. Days like this are better spent at home.”

Talk to your healthcare provider about other lifestyle changes that may help with your shortness of breath.

Join the Conversation

On myPHteam, people share their experiences with pulmonary hypertension, get advice, and find support from others who understand.

Which treatments have improved your shortness of breath? Let others know in the comments below.