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Difference between Dyspnea and Orthopnea

Breathing disorders affect millions of people across the globe. Americans spend over $20 billion in annual healthcare expenditure for Asthma alone.  Most disorders are signs or symptom of an underlying disease. Dyspnea and orthopnea are two common disorders linked respiratory disorders.

These two terms are often interchangeably used to describe shortness of breath. However they are signs of different diseases in the body. Confusing the two conditions may cause a patient to be misdiagnosed.


Dyspnea is shortness of breath on exertion. It is also explained as “air-hunger.” People with dyspnea have a very uncomfortable urge to breathe that is brought on by an interruption of normal breathing patterns.

Dyspnea can occur in two states while idle or on exertion. Patients suffering from dyspnea vary depending on variables such as gender, body weight, attitude, mental conditioning, age and emotional motivation. If symptoms of shortness of breath persist for at least four weeks, it’s considered chronic.

Orthopnea is  a medical disorder that is characterized by a shortness of breath brought on when lying flat. Individuals experience Orthopnea usually during nighttime when lying down and when they sit up, they get temporary relief.

Causes of Dyspnea and Orthopnea

Dyspnea causes a patient to feel the uncomfortable need to breath that leads to shortness of breath. Shortness of breath is the physiological response of the body to higher than normal concentrations of carbon dioxide in the body. This occurs when the normal breathing patterns are interrupted.

An imbalance arises in the gaseous exchange in tissues as oxygen levels decrease while carbon dioxide levels increase. The imbalance causes the respiratory system to the brain to increase the rate of respiration in order to increase oxygen levels while reducing carbon dioxide before it gets toxic.

Other causes of dyspnea include:

  • Chronic asthma
  • Chronic disruptive pulmonary disease
  • Chronic heart failure
  • Congenital heart diseases,
  • Congestive cardiac failure
  • Myocardial ischemia
  • COPD
  • Bronchial carcinoma
  • Emphysema,
  • Gastroesophageal
  • Reflux disease
  • Obstructive sleep apnea
  • Interstitial lung disease
  • Chronic pulmonary thromboembolism
  • Large pleural effusion
  • Lymphatic carcinomatosis

Orthopnea is a symptom of heart disease. Individuals with a weak heart, which has difficulty in pumping oxygenated blood throughout the body. When they lie down the volume of blood gets does not get redistributed as it should. Thus, the ventricle pumping blood away from the lungs has a hard time. The lack of proper redistribution of blood by the heart causes shortness of breath.

High blood pressure in the lungs is also another primary cause of Orthopnea. When there is an increased pressure in the veins. The amount of oxygen to the heart from the lungs decreases. In the heart, where the right ventricle is pumping more deoxygenated blood compared to the left ventricle’s oxygenated blood into the aorta in order to circulate blood to the rest of the body.

This imbalance causes higher blood pressure is in the veins that transport blood to the heart from the lungs. The higher blood pressure moves to the lungs, causing shortness of breath.

Other causes of Orthopnea:

  • Panic attacks
  • Asthma
  • Chronic bronchitis
  • Sleep apnea
  • Paralysis of one or both breathing diaphragm muscle
  • Polycystic liver disease
  • Enlarged  thyroid glands, which can block airflow in the upper airways when lying down. 
  • Upper respiratory tract Infections – caused by a congested nose and inflamed tonsils.
  • Severe pneumonia
  • Pleural effusion
  • Ascites

Breathing disorders are caused by a number of factors; a great preventive tool is establishing healthier eating habits..


Dyspnea and Orthopnea are both conditions that lead to shortness of breath. Patients usually complain of shortness of breath and feel like they are suffocating. Both conditions can exhibit similar signs that include coughing, palpitations and wheezing.

Patients with Orthopnea only experience breathing problems while lying flat down while patients with Dyspnea have shortness of breath even when sited.

Symptoms associated with Orthopnea include:

  • Shortness of breath on lying flat.
  • Persistent coughing
  • Ankle swelling
  • Need of having many pillows for sleeping with the upper body
  • Pedal edema
  • Paroxysmal nocturnal dyspnea (waking up suddenly due to shortness of breath that disappears when you sit up.)
  • Sporadic chest pain
  • Dysphasia
  • Hoarseness of voice
  • Palpitations
  • Cyanosis

Signs and symptoms of dyspnea include the following:

Shortness of breath can simply be a case of being out of shape, and exercise can improve symptoms. However, dyspnea is often a sign of a serious health problem, you should look out for the following signs.

  • Tight chest or pain when breathing
  • Persistent cough
  • Coarse or high-pitched noise when you breathe
  • Pale and sweaty, cool skin
  • Confusion and tiredness
  • Bluish-gray lips or nails

Treatment differences between Orthopnea and Dyspnea

Orthopnea Treatment Options

Treating Orthopnea is usually means treating the underlying cause which often is heart failure.  Sitting up when an attack occurs only offers a temporary relief. The most common treatments include the following:

  1. Anti-inflammatory medication
  2. Pericardiocentesis
  3. Open heart surgery.

Other types of treatment include vasodilators, diuretics and inotropic medication.

Dyspnea treatment options

Treatment for will ultimately depend on the underlying cause. Dyspnea is usually symptomatic of a variety of disorders, both acute and chronic. 

Acute dyspnea constitutes acute infections and inflammations of the respiratory tract. They may also be caused by obstruction by an inhaled foreign object, or trauma damage to to the chest cavity.

Patients with dyspnea must be diagnosed after a careful history and physical examination by a qualified physician. Dyspnea is usually due to cardiac or pulmonary disease, which is readily identified with Chest radiographs, electrocardiograph and screening spirometer.

Treatment should be carried out based on the suspected etiological condition.

  • Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis –  patients may have an inhaled rescue bronchodilator to use when necessary
  • Poor physical conditioning – taking time to adjust t higher altitudes and quitting smoking
  • obesity – Losing weight and maintaining a healthy diet
  • Asthma – inhalers and/or medications such as bronchodilators and steroids.