7 Common Atelectasis Symptoms You Should Know

Atelectasis is a medical condition that occurs when part or all of a lung collapses due to the deflation of the tiny air sacs called alveoli. This condition can range from mild cases affecting a small portion of the lung to severe cases involving an entire lung. Understanding the symptoms of atelectasis is crucial for early detection and proper medical intervention. While some cases may produce no noticeable symptoms, especially when only a small area is affected, more extensive atelectasis can lead to significant respiratory distress and other complications.

The severity of symptoms often depends on how quickly the collapse occurs and how much lung tissue is affected. Recognizing these warning signs can help individuals seek timely medical care and prevent potential complications. Below are the most common symptoms associated with atelectasis.

1. Difficulty Breathing (Dyspnea)

Difficulty breathing, medically known as dyspnea, is one of the most prominent symptoms of atelectasis. When a portion of the lung collapses, the available surface area for oxygen exchange decreases, forcing the body to work harder to obtain adequate oxygen.

Patients often describe this sensation as:

• Feeling unable to take a deep breath
• Experiencing a sense of air hunger
• Breathing rapidly or shallowly
• Feeling breathless even during minimal physical activity

The severity of breathing difficulty typically correlates with the extent of lung collapse. Small areas of atelectasis may cause only mild shortness of breath during exertion, while larger collapses can result in severe respiratory distress even at rest. This symptom often worsens when lying flat and may improve slightly when sitting upright, as gravity helps the unaffected portions of the lung expand more effectively.

2. Rapid, Shallow Breathing (Tachypnea)

Tachypnea, or rapid shallow breathing, develops as the body attempts to compensate for reduced lung capacity. When atelectasis occurs, the respiratory system automatically increases the breathing rate to maintain adequate oxygen levels in the blood.

This compensatory mechanism manifests as:

• Breathing rate exceeding 20 breaths per minute in adults
• Quick, short breaths rather than deep, full respirations
• Visible chest movement that appears faster than normal
• Increased work of breathing that may be exhausting

While rapid breathing helps maintain oxygen delivery temporarily, it is not sustainable long-term and indicates that the body is under respiratory stress. This symptom is particularly noticeable in acute cases of atelectasis and may be accompanied by visible use of accessory breathing muscles in the neck and shoulders.

3. Chest Pain

Chest pain associated with atelectasis can vary in intensity and character depending on the underlying cause and extent of lung collapse. This discomfort occurs because the collapsed lung tissue and surrounding structures become irritated or strained.

Characteristics of atelectasis-related chest pain include:

• Sharp or stabbing pain that worsens with deep breathing or coughing
• Dull, aching discomfort in the affected area
• Pain that may radiate to the shoulder or back
• Tenderness when touching the chest wall over the affected area

The pain often intensifies during inhalation because the expanding chest cavity pulls on the collapsed lung tissue. Some patients may instinctively breathe more shallowly to avoid triggering the pain, which can unfortunately worsen the atelectasis by further reducing lung expansion. If the atelectasis is caused by an obstruction or infection, the pain may be accompanied by inflammation of the pleura (pleuritis), creating a characteristic sharp, stabbing sensation.

4. Coughing

Coughing is a common symptom of atelectasis and serves as the body’s natural mechanism to clear airways and re-expand collapsed lung tissue. The cough may develop as the respiratory system attempts to remove any obstruction or mucus that contributed to the collapse.

The cough associated with atelectasis may present as:

• Dry, hacking cough without mucus production
• Productive cough with thick, discolored sputum if infection is present
• Persistent cough that worsens at certain times of day
• Cough triggered by deep breathing or position changes

In post-surgical patients, pain from the incision may prevent effective coughing, creating a cycle where inadequate cough leads to mucus accumulation, which then worsens the atelectasis. The characteristics of the cough can provide important clues about the underlying cause—a dry cough might suggest compression from an external source, while a productive cough with colored sputum may indicate an infection or mucus plug.

5. Low Oxygen Levels (Hypoxemia)

Hypoxemia, or decreased oxygen levels in the blood, occurs when atelectasis reduces the lung’s ability to transfer oxygen from inhaled air into the bloodstream. This is a serious symptom that may not always be immediately apparent to the patient but can be detected through medical testing.

Signs and symptoms of hypoxemia include:

• Bluish discoloration of the lips, fingertips, or skin (cyanosis)
• Confusion, restlessness, or changes in mental status
• Increased heart rate as the body attempts to circulate oxygen more quickly
• Fatigue and weakness due to inadequate oxygen delivery to tissues
• Headache, particularly in the morning

Healthcare providers typically measure oxygen levels using a pulse oximeter, a small device placed on the fingertip. Normal oxygen saturation levels are typically 95-100%, and levels below 90% are considered concerning. In cases of significant atelectasis, oxygen saturation may drop substantially, requiring supplemental oxygen therapy. Chronic hypoxemia can lead to complications affecting the heart, brain, and other organs if left untreated.

6. Decreased Breath Sounds

Decreased or absent breath sounds over the affected area is a clinical finding that healthcare providers detect during physical examination using a stethoscope. While patients cannot identify this symptom themselves, it is an important diagnostic indicator of atelectasis.

This finding occurs because:

• Collapsed lung tissue does not transmit air movement sounds
• Less air flows through the affected portion of the lung
• The density of collapsed tissue prevents sound transmission

During examination, a physician will listen to both lungs and compare the sounds. In atelectasis, the affected side will have noticeably reduced or absent breath sounds compared to the healthy side. This asymmetry is a key diagnostic clue. Additionally, the physician may detect other abnormal sounds such as crackles or wheezing, depending on whether fluid, mucus, or airway narrowing is present. The location and extent of decreased breath sounds help determine which portion of the lung is affected.

7. Fever (If Infection is Present)

Fever may develop as a symptom of atelectasis, particularly when the condition leads to or is accompanied by a lung infection such as pneumonia. Collapsed lung tissue is more susceptible to infection because mucus and secretions can become trapped, creating an ideal environment for bacterial growth.

Fever related to atelectasis typically presents with:

• Body temperature above 38°C (100.4°F)
• Chills and sweating
• General feeling of being unwell (malaise)
• Increased respiratory symptoms
• Production of discolored or foul-smelling sputum

Post-operative atelectasis is one of the most common causes of fever in the first 48 hours after surgery, though fever developing later may indicate a true infection. The presence of fever alongside other atelectasis symptoms warrants immediate medical attention, as it may signal that the condition has progressed to a more serious stage requiring antibiotic treatment or other interventions. Not all cases of atelectasis involve fever; its presence specifically suggests an infectious or inflammatory component.

What Causes Atelectasis in the Lungs

Understanding the causes of atelectasis is essential for prevention and early recognition. Atelectasis can develop through several mechanisms, and identifying the underlying cause is crucial for appropriate management.

Obstructive Causes

Obstructive atelectasis occurs when something blocks the airways, preventing air from reaching the alveoli:

• Mucus plugs: Thick secretions that accumulate and block airways, common after surgery, in people with chronic lung diseases, or during prolonged bed rest
• Foreign objects: Particularly in children who may accidentally inhale small objects or food particles
• Tumors: Growths inside or pressing on airways can obstruct airflow
• Blood clots: Rarely, blood clots may block airways

Compressive Causes

Compression atelectasis develops when external pressure prevents lung expansion:

• Pleural effusion: Fluid accumulation in the space surrounding the lungs
• Pneumothorax: Air leaking into the chest cavity
• Tumors: Masses outside the lung pressing against it
• Enlarged heart: Cardiac enlargement compressing adjacent lung tissue

Post-Surgical Causes

Surgery, especially chest or abdominal procedures, is a leading cause of atelectasis:

• Anesthesia effects: General anesthesia temporarily reduces normal breathing reflexes and surfactant production
• Shallow breathing: Post-operative pain leads to limited chest expansion
• Reduced mobility: Prolonged bed rest prevents deep breathing and effective coughing
• Medications: Pain medications may suppress the cough reflex and reduce respiratory drive

Other Contributing Factors

• Respiratory conditions: Asthma, COPD, cystic fibrosis, and bronchiectasis increase risk
• Chest trauma: Rib fractures or chest injuries limit breathing ability
• Prolonged immobility: Extended bed rest without position changes
• Shallow breathing patterns: Conditions causing chronic shallow breathing
• Neuromuscular diseases: Conditions affecting breathing muscles like muscular dystrophy
• Premature birth: Inadequate surfactant production in premature infants

Prevention of Atelectasis

While not all cases of atelectasis can be prevented, several strategies can significantly reduce the risk, especially in high-risk situations such as after surgery or during prolonged illness.

Pre-Operative and Post-Operative Measures

• Smoking cessation: Quit smoking at least several weeks before scheduled surgery to improve lung function and reduce mucus production
• Incentive spirometry: Use a breathing device that encourages deep, slow breaths to fully expand the lungs multiple times per hour after surgery
• Early mobilization: Get out of bed and walk as soon as permitted after surgery to promote deeper breathing
• Effective pain management: Control pain adequately to allow for deep breathing and coughing without excessive discomfort
• Regular coughing and deep breathing exercises: Perform these exercises every 1-2 hours while awake, even if uncomfortable

For Individuals with Chronic Conditions

• Airway clearance techniques: Learn and practice methods to clear mucus, such as controlled coughing, chest physiotherapy, or using flutter valves
• Stay hydrated: Adequate fluid intake helps thin mucus secretions, making them easier to clear
• Manage underlying conditions: Keep chronic lung diseases like asthma or COPD well-controlled with appropriate medical care
• Vaccinations: Stay current with flu and pneumonia vaccines to reduce infection risk
• Maintain physical activity: Regular exercise promotes lung health and prevents mucus accumulation

General Preventive Strategies

• Position changes: For bedridden individuals, change positions frequently to prevent compression of lung tissue
• Elevate the head of the bed: Sleeping with the upper body slightly elevated promotes better lung expansion
• Practice deep breathing: Even when healthy, regular deep breathing exercises maintain lung elasticity
• Supervise young children: Prevent aspiration of foreign objects by monitoring children during meals and keeping small objects out of reach
• Attend regular medical check-ups: Early detection and management of conditions that may lead to atelectasis

For individuals at high risk, healthcare providers may recommend additional preventive measures such as positive airway pressure devices or specialized breathing treatments. It is important to discuss personal risk factors and appropriate prevention strategies with a healthcare provider, especially before planned surgeries or procedures.

Frequently Asked Questions About Atelectasis

Can atelectasis go away on its own?

Minor atelectasis, particularly small areas affecting a limited portion of the lung, may resolve spontaneously with deep breathing exercises, coughing, and increased mobility. However, more significant cases typically require medical intervention such as breathing treatments, chest physiotherapy, or procedures to remove airway obstructions. It is important to consult a healthcare provider rather than waiting for the condition to resolve without treatment.

How serious is atelectasis?

The severity of atelectasis varies greatly depending on the extent of lung collapse and underlying causes. Small areas of atelectasis may cause minimal symptoms and pose little immediate danger, while extensive collapse affecting large portions of lung tissue can lead to severe respiratory distress, significant oxygen deprivation, and potential complications such as pneumonia or respiratory failure. Any suspected atelectasis should be evaluated by a healthcare professional to determine appropriate management.

How long does it take for atelectasis to develop?

Atelectasis can develop rapidly within hours, such as in cases of sudden airway obstruction or after surgery, or it may develop gradually over days or weeks in cases of slow-growing tumors or progressive mucus accumulation. Post-operative atelectasis often appears within the first 24-48 hours after surgery, which is why early mobilization and breathing exercises are emphasized during recovery.

Who is at highest risk for developing atelectasis?

Individuals at highest risk include those who have recently undergone chest or abdominal surgery, people with chronic lung diseases such as COPD or asthma, smokers, individuals with neuromuscular disorders affecting breathing, those on prolonged bed rest, elderly patients, obese individuals, and premature infants with insufficient surfactant production. Anyone with conditions that limit deep breathing or effective coughing faces increased risk.

Can atelectasis be detected on a regular chest X-ray?

Yes, chest X-rays are the primary imaging tool for detecting atelectasis. Collapsed lung tissue appears as areas of increased density or opacity on the X-ray, and the imaging may also show associated findings such as displacement of structures, elevation of the diaphragm, or compensatory hyperinflation of unaffected lung regions. In some cases, CT scans may be needed for more detailed evaluation, particularly when determining the cause of the atelectasis.

Is atelectasis the same as a collapsed lung (pneumothorax)?

No, atelectasis and pneumothorax are different conditions, though both involve lung collapse. Atelectasis occurs when the air sacs within the lung deflate due to obstruction, compression, or other causes, while pneumothorax occurs when air leaks into the space between the lung and chest wall, causing the lung to collapse from external pressure. They have different causes, treatments, and implications, though both require medical attention.

Can you exercise with atelectasis?

Exercise recommendations depend on the severity of atelectasis and overall respiratory function. Mild atelectasis may actually benefit from gentle activity and movement, as physical activity promotes deeper breathing and helps re-expand collapsed lung tissue. However, more severe cases may require rest and medical treatment before resuming physical activity. Always consult with a healthcare provider before exercising if diagnosed with atelectasis, as they can provide personalized recommendations based on individual circumstances.

Does atelectasis cause permanent lung damage?

Most cases of atelectasis, when treated promptly and appropriately, resolve completely without permanent damage. However, chronic or recurrent atelectasis, especially when associated with infection or prolonged collapse, may lead to permanent changes in lung tissue such as fibrosis or bronchiectasis. Early recognition and treatment are key to preventing long-term complications and ensuring full recovery of lung function.

References:

• Mayo Clinic – Atelectasis
• Johns Hopkins Medicine – Atelectasis
• American Lung Association – Atelectasis
• National Heart, Lung, and Blood Institute – Atelectasis
• MedlinePlus – Atelectasis