Published Jan 27, 2026 | 7:00 AM ⚊ Updated Jan 27, 2026 | 7:00 AM
In chronic inflammatory lung conditions such as asthma, the chest X-ray often remains normal.
Synopsis: Many patients report persistent breathlessness even when chest X-rays and lung tests appear normal. Doctors say breathing depends not just on the lungs but also on the heart, blood, muscles and nervous system, and conditions such as asthma, heart disease, anxiety and acid reflux can all cause breathing discomfort. Experts stress that when lung causes are ruled out, a careful evaluation of other medical factors, including allergies, inflammation and digestive problems, is essential.
Picture this: a patient describes a suffocating tightness or a desperate struggle for air, but their chest X-ray is clear and their lung function test (spirometry) comes back “perfect”. This plays out in clinics every day.
If the lungs are fine, why does breathing feel so difficult?
Pulmonologists and general physicians whom South First spoke to explain that when people think about breathing, they usually think only of the lungs.
But “respiration is a complex relay race involving the heart, the blood, the muscles and the nervous system”, says Dr Sanjay G, a physician from Bengaluru.
“When a standard lung test, which mainly measures how much air you can blow out, comes back normal, doctors must look at the ‘hidden’ links in the chain,” he explains.
In chronic inflammatory lung conditions such as asthma, the chest X-ray often remains normal, explains Dr Gayatri S Pandit, a renowned ENT and allergy specialist at Samarth ENT and Allergy Centre in Bengaluru, speaking to South First.
In such cases, pulmonary function tests remain an important tool to diagnose obstructive airway disease, she said.
Breathlessness, frequent sighing, or the need to take deep breaths is not always just a lung issue, says Dr Sameer Bansal, senior consultant pulmonologist at Vaayu Chest and Sleep Specialists.
“Generally, if there is an underlying lung problem, people feel breathless while walking or climbing stairs, along with symptoms such as cough. In cases of allergy or asthma, other lung tests may be normal,” he told South First.
“Oxygen levels may be normal, X-ray may be normal, but a person may still have asthma, with episodic issues due to exposure to pollution. One thing to remember is there might be a lung issue even if all of this is normal.”
Still, doctors stress that if pulmonary causes are ruled out, other possible reasons for breathlessness must be considered.
One such reason could be a cardiac issue showing up as breathlessness. Some signs to look for include swelling of the feet, breathlessness while lying down, getting breathless after a short walk, or a strong family history of heart disease.
In these cases, even when the lungs are fine, the heart needs to be checked.
Similarly, when a person is anxious, they often start breathing faster and deeper (hyperventilation) than the body needs without realising it, and this alone can trigger breathlessness.
Anxiety-related breathlessness is often overlooked, according to Dr Sameer Bansal.
Gastroenterologist Dr Rajeev Jayadevan explains that the frequent need to take long, deep breaths or sigh repeatedly is not typically a sign of lung, heart, or gastrointestinal disease.
“As long as vital signs are normal and oxygen saturation is within the normal range, it is quite possible that these symptoms are related to anxiety,” he says.
Unlike infections or visible illnesses, anxiety often has no outward signs. “Most people with anxiety do not even realise that they have it,” Dr Jayadevan explains.
Deep sighing, he adds, is a classic symptom. On probing further, patients may report poor sleep, excessive worrying, or catastrophising, where relatively minor, everyday issues are perceived as overwhelming or disastrous.
They may also have emotional outbursts, and family members or colleagues often describe feeling like they are “walking on eggshells” around them. Chest discomfort and palpitations—an increased awareness of one’s heartbeat—are also common, and anxiety is one of several possible causes.
Gastritis or acid reflux can also feel like breathlessness because it irritates and tightens the area around the chest.
When acid repeatedly splashes up, it can inflame the food pipe and cause a burning or heavy sensation that mimics chest pain. The stomach may feel bloated or full, and that pressure can push the diaphragm upwards, making breathing feel shallow.
Many also experience a “lump in the throat”, frequent burping, or a constant need to clear the throat, all of which can be mistaken for a breathing problem.
In some, reflux can even trigger a mild cough or wheeze, especially at night or after heavy meals, making it feel as though the airways are irritated.
Dr Jayadevan points out that many patients report a cluster of gut-related symptoms alongside breathing discomfort.
“A significant number of people who come to us describe a sensation that the breath gets stuck halfway, a need to take very deep breaths from time to time, bloating, frequent burping, or an inability to stop burping,” he says. Some also report bowel disturbances, such as increased frequency of bowel movements, along with abdominal bloating and discomfort rather than severe pain.
These symptoms, he explains, fall under what are now called disorders of gut–brain interaction, earlier known as functional gastrointestinal disorders or irritable bowel syndrome.
“Doctors tend to keep changing the names, but it is essentially the same condition,” he says, referring to the complex interaction between the gut, brain, and nervous system that can amplify physical sensations without structural disease.
Beyond these issues, there are a few practical clinical possibilities to consider.
Chronic allergic rhinitis can block the nose due to long-standing inflammation. This reduces airflow and forces mouth breathing, which can lead to daytime fatigue, explains Dr Vyakarnam Nageshwar, a super specialist in allergy, immunology, and inflammation in Telangana.
Allergic bronchitis, where allergy-triggered airway irritation causes chest tightness, is another possibility.
He also points to pulmonary embolism, a rare but important condition to rule out, especially when pulmonary function tests are normal. In this condition, a sudden clot in the lungs can cause sharp, localised pain that worsens with deep breaths.
Other considerations include hyperventilation syndrome, minor localised chest injuries, and pleural involvement, where an infection inflames the lining around the lungs and causes sharp “pleuritic” pain along with breathlessness. Certain types of anaemia can also contribute.
Patients may also complain of breathing difficulty due to upper airway problems such as a significantly deviated nasal septum, nasal polyps, sinus disease, and enlarged adenoids in children, says Dr Pandit.
This is why a thorough nasal and upper airway examination is important in patients who present with breathlessness, she explains.
“Burning sensation in the throat, constant burping, and poor eating habits are also pointers, and these can sometimes be linked to breathlessness,” she adds.
(Edited by Dese Gowda)
