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When It’s Hard to Breathe: Could it be Lyme?
Shortness of breath can feel frightening — especially when it strikes without warning or a clear cause. While heart and lung conditions are common culprits, there’s another, often-overlooked possibility: Lyme disease. This tick-borne infection doesn’t just cause joint pain and fatigue—it can also affect the nervous system, muscles, and even the way your body regulates breathing.
Shortness of Breath: An Often Overlooked Symptom
Many Lyme disease patients describe episodes of shortness of breath. For some, it’s a subtle struggle to take a full breath. For others, it’s chest tightness, air hunger, or a racing heart after climbing stairs. These symptoms are often dismissed but they deserve more careful evaluation.
I’ve found that several conditions can trigger new or worsening shortness of breath such as POTS (Postural Orthostatic Tachycardia Syndrome), Babesia, Lyme carditis, or even immune-mediated respiratory inflammation.
Asking the Right Questions
I’ll always ask:
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When does the breathlessness occur — at rest, with exertion, or lying down?
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Are there palpitations, dizziness, or chest discomfort?
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Is it acute or chronic?
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Have symptoms changed over time?
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Is there a history of tick exposure or known Lyme co-infections?
What Shortness of Breath Can Mean in Lyme Disease
Autonomic Dysfunction (POTS)
Shortness of breath in Lyme disease is often linked to POTS. Standing or exertion causes a racing heart and lightheadedness — often mistaken for panic attacks.
Babesia Co-Infection
Babesia can cause air hunger, night sweats, and chest pressure. It’s often underdiagnosed, but treatment can relieve breathlessness.
Lyme Carditis
Patients with Lyme-related heart block or arrhythmia may struggle with shortness of breath doing even basic tasks like walking across the room.
Respiratory Inflammation and Immune Response
Lyme can trigger pulmonary inflammation, phrenic nerve dysfunction, or vocal cord issues. In some cases, the inflammatory response — not direct infection — can impact the lungs, causing: chest tightness, air hunger, mild hypoxia, and non-productive cough.
This is especially common during Herxheimer reactions or in late-stage Lyme.
When to Seek Urgent Evaluation
Breathlessness should never be ignored. Red flags that warrant prompt evaluation include:
• Difficulty breathing at rest
• Inability to lie flat comfortably
• Chest pain or a rapid or irregular heartbeat
• Swelling in one leg (which may signal a blood clot)
• Symptoms that worsen over days or weeks
These signs may indicate serious conditions beyond Lyme disease, such as cardiac, pulmonary, or vascular causes. A medical workup may include oxygen saturation, ECG, chest x-ray, and echocardiogram. Evaluation should begin with your primary care provider and may involve referrals to specialists as needed to rule out life-threatening causes.
The Role of Primary Care in Lyme-Related Dyspnea
Primary care is often where patients first report shortness of breath in Lyme disease. A careful clinical history—especially one that includes tick exposure, co-infection risk, and neurologic symptoms—can change the course of diagnosis.
These symptoms are physiologic, not psychological. A diagnosis of anxiety without a workup misses too many Lyme-related causes.
What Patients Can Do
If you have Lyme disease and are experiencing shortness of breath:
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Track when and how it occurs
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Pay attention to posture, exertion, meals, and recovery
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Ask your provider about POTS, Babesia, or Lyme carditis
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Advocate for testing if you feel dismissed
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Don’t assume it’s “just anxiety”
Final Thoughts
Shortness of breath in Lyme disease is real. It may be caused by dysautonomia, co-infections, cardiac issues, or immune reactivity. Treating the root cause, not just the symptom, can restore function and improve quality of life. The right evaluation can be life-changing.
Have you experienced shortness of breath in Lyme disease? Share your story in the comments.
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I had significant SOB with Lyme disease. I was constantly SOB and in the second month of my symptoms it slowly worsened over the course of 3 weeks until I ended up in the ER where I got oxygen and felt so much better. I then started hyperbaric treatments a month later and eventually it got much better. So yes I agree Shortness of breath is definitely real with Lyme.
I look for evidence of Babesia if my patient is being evaluated for a tick bore illness.
It could also be due to MCAS which is very often diagnosed alongside Lyme and other illnesses like long covid. I think this is an important thing that’s been missed from this article.
thanks for sharing. It is still worth a second look for Babesia even if patient with MCAS
My husband more than likely hasn’t been bitten for over 20 years (you never know, he does walk in a city (Chicago) park–but…). He was treated for “Lyme” 2 times and we were bitten almost daily for years we lived in endemic Hudson River Valley. Exactly 7 days after a laser focused brain surgery to correct essential tremor, he developed sudden onset SOB. 1 hospitalization and three ER’s + 2 Urgent cares = no diagnosis. Cardio workup and some lung workup (still awaiting results of one test) ALL CLEAR. Fortunately we found a Functional Medicine MD who just dx’d Long Covid (husband had it 2 times- last time was 2023) and Lyme. Igenex testing sent off, and we insisted on doing Babesia. Ozone tx + several supplements, LDN. At home we will do our own protocol = nebulized glutathione, nebulized essential oils, (Buhner Pulmonary monographs) and other. Pending Igenex will proceed to possible abx. The functional medicine MD has treated many long covid pts. with success, and is Lyme literate. We are very lucky. Yesterday cardio looked nonplussed when we mentioned “Lyme” and tick borne illness resurfacing in this way and was party line on long covid. We are VERY fortunate that we knew what to do and found this doctor. As always grateful for your information Dr. Cameron. Your thoughts on the stealth Odocoilei would be appreciated. IgeneX says they are testing for it, but I understand it’s harder to detect and may be an underlying factor for many refractory cases.
I an sorry your husband when through so much. It is always hard juggle multiple issues. I am waiting to learn more about Odocoilei before posting
Yes, thank you so much. Since writing last, a functional med doctor has dx’d Long Covid, which as we know is strictly based on clinical symptoms. Due to hx with multiple tick bites (daily) in Upstate NY, and three + tx for the bullseye rashes + rx with doxy —Odocoilei needs to be ruled out with the more sensitive testing available today than what was/is available at the moment (Igenex, does its best), he is negative per IgeneX) As you can see very complex as you have a pt with known TBD previously treated, BUT current: sudden onset SOB after laser focused brain surgery to correct familial essential tremor. Symptoms include profound GI discomfort et alia, many. compatible with the known dysbiosis associated with long covid. 2 positive covid tests= last one in Dec. 2024 (seemingly smooth recovery) Now sudden onset profound fatigue (although has presented with fatigue even prior to Covid infections) and severe gastro symptoms, new SOB. Plan: work on mitochondrial support and recent research/tx sudies for lowering cytokines and boosting immunity. Really think Odocoilei needs to be r/o. Thanks for any thoughts you might share.