Based on PubMed | Can fibromyalgia cause shortness of breath, and how should this symptom be evaluated and managed?

Fibromyalgia can be associated with a sensation of shortness of breath (dyspnea), but it typically does not stem from lung or heart disease in most cases of fibromyalgia itself. ^[1] In people with fibromyalgia, dyspnea often appears during exertion and may relate to factors such as deconditioning, altered breathing patterns, respiratory muscle weakness, heightened pain sensitivity, poor sleep, and anxiety. ^{[1] [2]}

What the research shows

• Prevalence: In a cohort of women with chronic primary fibromyalgia, about 84% reported some degree of dyspnea, most commonly with activity. ^[1] Higher self-reported dyspnea levels correlated with reduced exercise capacity and higher resting breathing rates. ^[1]
• Mechanisms: Studies found that maximal inspiratory and expiratory pressures (simple measures of respiratory muscle strength) were significantly lower in fibromyalgia compared with healthy controls, despite normal spirometry, suggesting respiratory muscle dysfunction as a contributor. ^[2] Importantly, typical lung function tests were normal, pointing away from intrinsic lung disease in many cases. ^[2]
• Contributing symptoms: Sleep problems, including co-existing conditions like sleep apnea, are common in fibromyalgia and can worsen fatigue and breathlessness sensations. ^[3] Poor sleep and stress also tend to amplify pain and autonomic symptoms in fibromyalgia. ^[4]

Why shortness of breath happens in fibromyalgia

• Respiratory muscle weakness: Lower inspiratory and expiratory pressures may make breathing feel harder during exertion even when lungs are normal. ^[2]
• Deconditioning: Reduced fitness lowers exercise tolerance and can increase ventilatory demand, intensifying the sensation of dyspnea. ^[1]
• Central sensitization and autonomic factors: Fibromyalgia involves heightened sensitivity to bodily signals, which can make normal breathing sensations feel uncomfortable or alarming. ^[5]
• Sleep disturbance: Fragmented sleep and possible sleep apnea worsen fatigue, exertional intolerance, and perceived breathlessness. ^[3]
• Anxiety and stress: These can raise breathing frequency and amplify dyspnea perception. ^[6]

Red flags that need urgent evaluation

• New, severe, or rapidly worsening shortness of breath at rest.
• Chest pain, pressure, or tightness.
• Fainting, bluish lips, marked leg swelling, or coughing up blood.
• Fever with cough and sputum, or wheezing if new.

These features may signal heart or lung disease and warrant emergency care rather than attribution to fibromyalgia alone.

How clinicians typically evaluate dyspnea in someone with fibromyalgia

• History and physical exam: Characterize onset, triggers (rest vs exertion), associated chest pain, palpitations, wheeze, cough, fever, swelling, anxiety, and sleep quality. A careful medication review is also important.
• Basic tests to rule out cardiopulmonary disease:
  • Pulse oximetry (oxygen saturation) at rest and possibly with exertion.
  • Chest exam and, if indicated, a chest X-ray.
  • Electrocardiogram (ECG).
  • Spirometry with bronchodilator if asthma/COPD is suspected; spirometry is often normal in fibromyalgia-related dyspnea. ^[2]
• Targeted tests based on findings:
  • Echocardiogram or stress testing if cardiac symptoms risk is present.
  • D-dimer/CT angiography if pulmonary embolism is a concern.
  • Full pulmonary function tests including diffusion capacity if interstitial disease is suspected.
  • Maximal inspiratory/expiratory pressures (MIP/MEP) to assess respiratory muscle strength; these may be low in fibromyalgia and can help explain symptoms when spirometry is normal. ^[2]
  • Sleep evaluation if snoring, witnessed apneas, or non-restorative sleep suggest sleep apnea, which is commonly comorbid and can worsen fatigue and dyspnea symptoms. ^[3]

Management approach

1) Treat comorbid conditions and red flags first

• Address any identified cardiac, pulmonary, thromboembolic, or infectious cause promptly.
• Evaluate and treat sleep apnea if present, as improving sleep can reduce fatigue and breathlessness sensations. ^[3]

2) Optimize fibromyalgia care

• Sleep and stress management: Improving sleep hygiene and managing stress can reduce pain and perceived dyspnea; poor sleep and stress are known to worsen fibromyalgia symptoms. ^[4]
• Graded activity: A gentle, progressive exercise program (e.g., walking, stationary cycling, aquatic therapy) can improve conditioning, reduce dyspnea, and enhance quality of life; exercise capacity correlates inversely with dyspnea ratings in fibromyalgia. ^[1]
• Pain control and central sensitization: Multimodal strategies (education, pacing, cognitive behavioral approaches, and appropriate medications when indicated) may lessen symptom amplification that contributes to dyspnea perception. ^[6]
• Anxiety management: Relaxation techniques, paced breathing, and psychological support may help reduce hyperventilation and the distress that magnifies breathlessness. ^[6]

3) Respiratory-focused strategies

• Breathing retraining: Diaphragmatic breathing, slower respiratory rates, and pursed-lip breathing can improve ventilatory efficiency and reduce the sensation of air hunger in individuals with altered breathing patterns. ^[6]
• Inspiratory muscle training (IMT): Given evidence of reduced inspiratory strength in fibromyalgia, supervised IMT using threshold devices may help improve MIP and perceived exertional dyspnea in select individuals, especially when MIP/MEP are low. ^[2]
• Posture and mobility: Thoracic mobility exercises and postural work can ease chest wall tension that sometimes contributes to a sense of restricted breathing. ^[6]

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At-a-glance: Evaluation and management workflow

• Step 1: Screen for urgent red flags → If present, emergency evaluation.
• Step 2: Basic assessment (history, exam, pulse oximetry, ECG, chest imaging if warranted, spirometry).
• Step 3: If unrevealing and symptoms persist → Consider MIP/MEP testing, sleep study, and targeted cardiopulmonary tests as indicated. ^{[2] [3]}
• Step 4: Treat comorbidities; initiate fibromyalgia-focused care with graded activity, sleep optimization, stress reduction, and breathing retraining. ^{[4] [6]}
• Step 5: Consider respiratory muscle training and physical therapy when inspiratory/expiratory pressures are low or deconditioning is prominent. ^[2]

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Simple home tips that may help

• Try slow, diaphragmatic breathing: Inhale through the nose for ~4 seconds, expand the belly, exhale through pursed lips for ~6 seconds; repeat for 5–10 minutes, especially before activity. ^[6]
• Pace activities: Break tasks into shorter bouts with planned rests; gradually increase duration as tolerance improves. ^[1]
• Sleep hygiene: Keep a consistent sleep schedule, limit caffeine late in the day, and create a dark, quiet bedroom; seek evaluation for snoring or witnessed apneas. ^[3]
• Gentle conditioning: Start with low-impact exercise 3–4 days per week, increasing by 10% per week as tolerated; consider water-based exercise if joint or muscle pain limits land activity. ^[1]
• Manage stress: Mindfulness, guided imagery, or yoga-based breathing can reduce anxiety-driven overbreathing. ^[6]

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Key takeaways

• Shortness of breath is common in fibromyalgia and often occurs without underlying heart or lung disease. ^[1] Many individuals show reduced respiratory muscle strength despite normal spirometry, which may help explain symptoms. ^[2]
• A careful evaluation is important to rule out cardiopulmonary causes and to identify treatable comorbidities like sleep apnea. ^[3]
• Management focuses on optimizing fibromyalgia care, improving fitness, retraining breathing, and addressing sleep and anxiety; these measures can meaningfully reduce the burden of dyspnea. ^{[4] [6]}

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Table: Distinguishing features of fibromyalgia-related dyspnea vs cardiopulmonary causes

• Typical onset

  • Fibromyalgia-related: Gradual, often with exertion; may fluctuate with stress, sleep quality, and pain. ^{[1] [4]}
  • Cardiopulmonary causes: Can be sudden or progressive; often linked to specific disease physiology.

• Lung tests

  • Fibromyalgia-related: Spirometry usually normal; MIP/MEP may be low. ^[2]
  • Cardiopulmonary causes: Spirometry abnormal in obstructive/restrictive disease; diffusion capacity may be reduced in interstitial disease; imaging/oxygenation may be abnormal.

• Associated signs

  • Fibromyalgia-related: Widespread pain, fatigue, poor sleep, anxiety; often normal exam and oxygen levels at rest. ^{[3] [4]}
  • Cardiopulmonary causes: Wheeze, rales, edema, cyanosis, abnormal ECG/echo, radiographic findings.

• Response to interventions

  • Fibromyalgia-related: May improve with graded exercise, breathing retraining, sleep and stress management, and inspiratory muscle training. ^{[1] [2] [6]}
  • Cardiopulmonary causes: Requires disease-specific therapy (e.g., bronchodilators, diuretics, anticoagulation, antibiotics).

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References

• Dyspnea is common in chronic primary fibromyalgia and correlates with reduced exercise capacity; not explained by routine cardiac/pulmonary testing. ^[1]
• Respiratory muscle strength (MIP/MEP) is lower in fibromyalgia despite normal spirometry, indicating potential respiratory muscle dysfunction. ^[2]
• Sleep problems are common in fibromyalgia; coexisting sleep apnea can occur and should be evaluated when suspected. ^[3]
• Poor sleep and stress can worsen fibromyalgia symptoms and perceived pain, which may amplify dyspnea. ^[4]
• Dyspnea perception involves central mechanisms and respiratory motor command; breathing retraining and anxiety reduction can help symptom control. ^[6]