I am a physician with knowledge of the condition many posters experience- knowledge based on seeing patients with it and experiencing it myself. I have previously posted but realize many haven't read all the posts. This post concerns those who have dyspnea/shortness of breath concerns that are unexplained after extensive evaluation and doesn't refer to those who are determined to have a cardiac or pulmonary cause. The general term given is dysfunctional breathing and there are different forms. The classic example is patients who hyperventilate (breath rapidly in excess of a normal rate of breathing); many posters experience air hunger or the feeling of not obtaining enough air which prompts them to take exaggerated inspirations/deep sighs; many mention yawning which is typical.
The exact underlying cause of this condition is not clear. It is generally agreed that there is a derangement in the ventilatory drive which is the natural control mechanism of breathing. There is an idea that you can become overly sensitive to CO2 leading to the increased ventilation rate or depth. There are various factors that impact the ventilatory drive but there are certainly psychological aspects to it which is why anxiety is often suggested as an underlying cause but it may not be as simple as someone being anxious and therefore short of breath. In my case, I have found underlying psychological stress about something to often be a factor. I feel many on here take issue with the introduction of a psychological basis for this symptom and perceive the doctor as blowing them off but it is a valid consideration, particularly when test after test for organic disease is reassuring. The fact that the condition may have origins psychologically should not be taken to mean the condition is not real because it definitely is and there are many somatic manifestations (physical symptoms) of psychiatric disease that are just as real as symptoms that have an organic basis.
Unfortunately, the general knowledge of this condition is lacking among most practitioners which leads to frustration in those experiencing it because it is difficult for most doctors to address patients who are so symptomatic but yet have no abnormalities on normal tests.
There is no agreed upon treatment and when you read through the posts, there are a wide variety of responses to a wide variety of treatments. Some have reflux and improve with treatment; some mention psychiatric medications; some do breathing exercises, some take various vitamins/supplements.
I suspect the most important aspect of improving is acceptance of the condition and a belief in whatever treatment that is pursued. The fact that typical tests are normal should provide reassurance- I understand that for many, normal tests leave them with unanswered questions/ wondering what's wrong but it is a good thing to not have heart or lung issues.
Some mention having had COVID as did I and breathlessness is one of the symptoms of long COVID so it will be interesting to see how this plays out as the understanding regarding COVID and its effects on people are better studied/understood. The primary question I would have is if you can see breathlessness in long COVID in patients who did not have lung involvement when they were actually sick with COVID.