Hi, I am sorry that your twin is not feeling well. Shortness of breath can be related to the heart, the lungs and surrounding structures, anemia and blockage of any of the upper airway passages such as the nose, throat or mouth. In addition, emotional stress or anxiety can cause shortness of breath. Shortness of breath may occur on its own or with other complaints which may help to pinpoint exactly which system of the body is causing the problem. In addition to your sister trying to figure out if there are any associated symptoms, she also has to see whether it occurs at rest ( while she is not active doing anything) or if the symptoms are brought on by activity. Also important is whether it is of gradual onset or sudden, how long the episodes last and what relieves them. The causes of shortness of breath can be divided into those caused by the heart: (1) angina ( blockage of blood vessels in the heart, usually the person would also have chest pain as well, starts on activity and if it worsens symptoms start occuring at rest, may also be associated with swelling of the feet and breaking out into a sweat when symptoms occur) (2) heart failure ( when the heart cannot supply the needs of the body --- shortness of breath, swelling of legs and eventually other parts of the body such as the abdomen , palpitations (3) abnormal rhymth of the heart LUNG (1) asthma (2) blood clot in the lung (3) infection in the lung - most persons would have a fever and cough (4) COPD (5) problems in upper airways leading to lung (6) inflammation of the lining of the lung - usually have history of previous infection Anemia- low red cell mass can be associated with shortness of breath , usually also have palpitations. There are different types and causes of anemia and if a person appears pale and the anemia is confirmed by blood tests then the doctor will figure out which type the person has so that he or she can be treated appropiately. OUR ENVIROMENT- if there are allergens in our enviroment that promote allergy like symptoms then they may cause shortness of breath EMOTIONAL DISTRESS such as anxiety can also cause shortness of breath and sometimes we may be unconsciously stressed about things. We normally think of this last and this would only be diagnosed after tests have been done to rule out the other possibilities. Depression is one of the rare side effects of dianette. Your sister should revisit her doctor to get a full history and examination to determine the exact cause of the symptoms. It should be followed by investigations which would be based on the results of the history and examination. I hope this is helpful to the both of you and wish you the best. Your sister should revisit