Dyspnoea (Breathlessness)

Breathlessness (dyspnoea) is an unpleasant sensation of uncomfortable, rapid or difficult breathing. People say they feel puffed, short of breath or winded. Your chest may feel tight and breathing may hurt. Everyone can experience breathlessness if they run for a bus or exert themselves to an unusual extent. But it is important to seek medical attention if you suffer from breathlessness, as it may be due to a serious underlying problem. The most common causes are mentioned below.

What is breathlessness?

Breathlessness is when you experience shortness of breath and difficulty breathing. The medical term is dyspnoea. It may come on suddenly (acute) or gradually over a period of time (chronic). The reason for breathlessness is that the body needs more oxygen than it is getting. So you breathe faster to try to increase the flow of oxygen-rich air into the lungs. From the lungs, oxygen gets into the bloodstream and is pumped round the body by the heart.

Who is affected by breathlessness?

Sudden severe breathlessness is one of the most common reasons that people call an ambulance or go to accident and emergency departments.

Breathlessness affects all of us when we exercise, especially if we are overweight or not very fit. But unpleasant breathlessness that comes on suddenly or unexpectedly can be due to a serious underlying medical condition. Pneumonia can affect the very young and very old, asthma tends to affect young children, smokers are at greater risk of lung and heart disease and the elderly may develop heart failure. However, all these conditions can affect any age group and severe breathlessness always needs medical attention.

How do you measure breathlessness?

Breathlessness can be measured using a score system devised by the Medical Research Council.

  1. No breathlessness.
  2. Breathless on vigorous exertion - for example, running.
  3. Breathless walking up slopes.
  4. Breathless walking at normal pace on the flat; having to stop from time to time.
  5. Stopping for breath after a few minutes on the level.
  6. Too breathless to leave the house.

What investigations will be advised?

The doctor will want to know more about what you were doing when you became breathless.

  • Did it start suddenly or develop over time? Did anything trigger it?
  • How far can you walk? Are you only breathless when you move? Is it worse when you lie down?
  • Do you feel ill? Do you have a fever, weight loss or a cough? Do you have any pain in your chest? 
  • Are you coughing up any phlegm (sputum)? What colour is it?
  • Have you lost weight, coughed up blood, been in contact with anyone with tuberculosis (TB) or travelled abroad recently?
  • Have you recently been bed-bound or on a long flight?
  • Do you smoke?

These details will help the doctor to make a diagnosis. Your doctor will examine you. He or she will check your heart, including your blood pressure and your lungs. You may be asked to have lung function tests including a peak flow reading. You may be sent for a chest X-ray. You may have blood tests for anaemia, an underactive thyroid gland, and heart failure. Further tests of your heart and lungs may be necessary.

What could it be caused by?

Short-term/recent (acute) breathlessness can be caused by:

  • Asthma - you may sound wheezy and breathless. May be triggered by a cold (viral infection) or allergy (for example, hay fever).
  • Pneumonia - a severe chest infection in which you get more breathless. You feel ill, have a fever and cough with greenish phlegm (sputum).
  • Chronic obstructive pulmonary disease (COPD) - a long-term lung condition causing breathlessness and cough. The airways become inflamed and narrowed. It may get suddenly worse as a result of a chest infection.
  • Heart disease - for example, heart failure where the heart doesn't pump properly. Because the heart pumps inefficiently in heart failure, there is a build-up of pressure in blood vessels which feed into the heart (veins). This increased pressure makes fluid build up in the body's tissues. Because of gravity, the extra fluid shows up as ankle swelling.
  • Pulmonary embolism - a clot in the lung. Usually due to a blood clot in the leg, which causes a painful, swollen calf. The clot develops after being immobile for a long time (for example, after a long-haul flight) and travels in the bloodstream to the lungs.
  • Anxiety - can cause breathlessness, feelings of panic, rapid heartbeat (palpitations) and sweating.
  • Other causes - including pain, and anaemia - can cause breathlessness.

Long-term (chronic) breathlessness:

You will have been breathless for some time and it may be getting steadily worse. Common causes include:

  • Obesity and lack of fitness.
  • Asthma - which is not well controlled.
  • COPD - lung disease usually due to smoking.
  • Heart failure - gradual onset of breathlessness, swollen ankles, and worse on lying down. It affects elderly people usually. It is due to the heart pumping inefficiently.
  • Heart rhythm problems - for example, and irregular heartbeat (atrial fibrillation) may make the heart work less well so oxygen isn't pumped around the body properly. This means you have to breathe rapidly to get more oxygen into your lungs. The rapid breathing makes you feel breathless.
  • Anaemia - not enough haemoglobin in the blood to carry oxygen to cells. This causes tiredness and breathlessness. The most common cause in the UK is heavy menstrual periods. Bleeding into the gut is a common cause in older people.

Treatment will depend on the likely cause of your breathlessness. You will be strongly encouraged to stop smoking if you are a smoker. You will probably be referred to a heart specialist (a cardiologist) or to a lung (respiratory) specialist, for further tests, depending on the most likely underlying cause. Most cases will be managed by your GP but you may be referred for further investigation and treatment at a hospital.

What can you do if you feel breathless?

  • Try not to panic, if possible.
  • Call 999 if severe and sudden with no obvious cause.
  • Call your GP urgently otherwise.
  • Use your reliever inhaler as instructed if you have asthma.
  • Use your oxygen if you have been supplied with it.

What should you do next?

You should call an ambulance if you suffer from unexpected and severe breathlessness that lasts more than a few minutes. Otherwise, you should call your GP urgently.

How can I avoid breathlessness?

You will need to find the underlying cause and try to address it if possible. Don't smoke, or get help to stop smoking because all common serious causes of breathlessness are more likely to affect smokers. If you maintain a normal weight and do regular exercise, you are less likely to get breathless.

What is the outlook (prognosis)?

This depends on the underlying cause but is generally very good. People with smoking-related diseases who continue to smoke, tend to get more and more breathless. Some people who are breathless will need oxygen.