Systemic lupus erythematosus (SLE) can cause shortness of breath, but it’s not the only possible cause. If you wake up feeling breathless, have trouble taking deep breaths during the day, or can’t seem to yawn, it’s a good idea to ask your doctor about it.

Lupus can affect the lungs in different ways, and dyspnea (the medical term for shortness of breath) can be a symptom of several lupus-related lung conditions. Treatment usually focuses on reducing inflammation and suppressing the immune system, but other medications or procedures may be needed. Waiting too long to get help can lead to lung damage and other complications, so don’t put off talking with your doctor.

🗳️ What do you find most challenging?

Side effects of treatments

Dealing with symptoms

Changes to my quality of life

All of the above

Thanks! You've successfully submitted your vote.

Sign up to view the results!

Continue with Facebook

Continue with Google

Continue with your email

By joining, you accept our Terms of Use, and acknowledge our collection, sharing, and use of your data in accordance with our Health Data and Privacy policies.

Already a Member? Log in

Common Lupus-Related Causes of Shortness of Breath

Lung conditions affect about half of all people living with lupus. Shortness of breath can result from pleuritis (inflammation around the lungs), pneumonitis (inflammation inside the lungs), pulmonary hypertension (high blood pressure in the lungs), blood clots in the lungs, a rare syndrome called shrinking lung syndrome, or even a heart issue.

The most common lung problem associated with lupus is pleuritis — inflammation of the membrane surrounding the lungs.

Pleuritis

Pleuritis (also called pleurisy) is the most common lung problem associated with lupus. It occurs when the lining around the lungs becomes inflamed, sometimes causing fluid to build up between the layers. Pleuritis can feel like a sharp, stabbing pain when you take a deep breath. When fluid builds up, it’s called a pleural effusion — this may feel more like pressure or squeezing in the chest that makes breathing hard, but it’s usually less painful than pleurisy.

Doctors can diagnose pleuritis with a chest X-ray. Treatment often includes anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids.

Pulmonary Hypertension

About 10 percent of people with lupus develop high blood pressure in the lungs. This occurs when the arteries between the heart and lungs thicken and narrow, making it harder for blood to flow. As a result, the heart has to work harder, which can eventually strain the heart and lead to heart failure (when the heart can’t pump blood properly).

Symptoms of pulmonary hypertension include shortness of breath, fatigue, and dizziness. Treatments may involve medications to lower blood pressure in the lungs, reduce inflammation, and suppress the immune system. Although the exact cause isn’t fully understood, pulmonary hypertension in lupus is believed to involve a mix of inflammation, immune system activity, and blood vessel changes. There are several types of pulmonary hypertension, and some respond well to treatment.

Lupus Pneumonitis

About 1 percent to 10 percent of people with lupus develop lupus pneumonitis. This form of lung inflammation can be triggered by lupus itself, infections, or damage from earlier inflammation.

Lung conditions affect about half of all people living with lupus.

Pneumonitis can be acute (appear suddenly) or chronic (develop over time). If this condition isn’t caught early and treated, it can cause lung scarring. Treatment typically starts with high doses of steroids. Immunosuppressive medications may also be used to control the immune system and reduce inflammation.

Blood Clots in Lungs

People with lupus may develop antiphospholipid syndrome, a condition in which the immune system makes unusual antibodies that increase the risk of blood clots. These blood clots can form in blood vessels anywhere in the body. If a clot breaks loose, travels to the lungs, and blocks blood flow, it can cause a pulmonary embolism, which is marked by shortness of breath and chest pain.

Pulmonary embolism is diagnosed using imaging scans and blood tests. Treatment usually includes blood thinners to dissolve the clot and prevent future ones. In some cases, long-term treatment or even surgery may be needed. About a third of people with SLE have antiphospholipid antibodies, which increase the risk of blood clots, so it’s important to talk with your healthcare provider about testing if you’re experiencing symptoms.

Shrinking Lung Syndrome

Shrinking lung syndrome is a rare complication that affects people with autoimmune disorders like lupus. Diagnostic scans show that half of the diaphragm — the main muscle involved in breathing — is higher than normal in the chest. This can make it hard to take a deep breath and may lead to ongoing shortness of breath or, in severe cases, respiratory failure.

Treatment for shrinking lung syndrome usually includes corticosteroids and medications to calm the immune system.

Pericarditis

Shortness of breath in lupus isn’t always due to lung problems. In some cases, the heart may be involved. Pericarditis, or inflammation of the sac around the heart, is one example. Other heart issues can be caused by lupus itself, medication side effects, or complications like high blood pressure from lupus nephritis (kidney inflammation). If lung tests are normal, your doctor may recommend checking your heart to rule out cardiac causes.

Other Conditions That Can Cause Shortness of Breath

It’s easy to blame lupus anytime you can’t take a deep breath, but many other conditions can also lead to shortness of breath, including some that require immediate medical attention. Here are a few common causes of shortness of breath that may not be related to lupus:

• Anaphylaxis — This severe, potentially life-threatening allergic reaction can cause airways to swell and requires immediate medical attention.
• Asthma — This chronic condition causes airways to become inflamed and narrow, leading to difficulty breathing.
• Chronic obstructive pulmonary disease (COPD) — Often linked to long-term exposure to cigarette smoke, COPD causes damage and inflammation in the airways.
• Respiratory infections — Viruses like influenza and COVID-19, bacteria like streptococcus, or fungi like aspergillus can all affect breathing. Shortness of breath can signal a severe infection and should be evaluated right away.
• Allergies — Also called hay fever or allergic rhinitis, allergies can cause a variety of symptoms that may include trouble breathing.
• Heart problems — Conditions like heart failure or valve disease cause fluid to back up into the lungs, causing breathing problems like shortness of breath.

Routine health screenings can help rule out various causes of breathing difficulties. Sometimes, healthcare providers may assume breathing problems are “just” part of lupus. You may need to advocate for yourself and ask for additional tests.

If you experience sudden or severe shortness of breath along with chest pain, fainting, blue nails or lips, an upset stomach, or poor alertness, you should seek immediate medical care.

One MyLupusTeam member described their experience doing just that: “I had been sharing the shortness of breath with several of the rheumatologists, but they didn’t say much since shortness of breath is common with lupus. I got referred to a pulmonologist and cardiologist by my primary care doctor. I received a heart failure diagnosis. I think sometimes you need to insist if you feel something is amiss.”

When To Talk With a Doctor

Sometimes shortness of breath is completely normal, such as when you’re fatigued. Talk with your doctor if you feel short of breath for no apparent reason. It could be related to lupus, and early treatment may help prevent complications like lung scarring. Depending on the cause, your doctor may recommend NSAIDs, steroids, immunosuppressants, or other treatments.

You should also schedule an appointment with a doctor if you:

• Hear a high-pitched wheeze when breathing
• Have trouble breathing while lying flat
• Notice swelling in your feet, ankles, or hands
• Find it hard to do everyday activities that used to feel easy
• Develop shortness of breath that doesn’t improve or keeps getting worse

Get immediate medical care if your shortness of breath comes on suddenly, feels severe, or happens during or after a long car or plane ride. These could be signs of a serious condition, especially along with:

• Chest pain
• Lightheadedness or fainting
• Blue nails or lips
• Nausea or vomiting
• Confusion or problems staying alert
• Leg pain and swelling

These symptoms could indicate a heart attack or blood clot in the lungs, and both conditions are medical emergencies.

Join the Conversation

On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

How does shortness of breath affect your daily life? Does it seem to coincide with other lupus symptoms? Let others know in the comments below.

Still have questions about your condition? I can help.