What is breathlessness?
Causes of short-term breathlessness
Causes of long-term breathlessness
Clues to what is causing your breathlessness
Questions your doctor might ask
Tests
Management of breathlessness
How do we measure breathlessness
What is breathlessness?
Everyone experiences breathlessness at some time, for example after heavy exercise or exertion you are not used to.
Breathlessness as a medical symptom is an unpleasant awareness of difficult or uncomfortable breathing that is greater than you would normally expect during exercise.
It is sometimes referred to as dyspnoea (pronounced disp-NEE-a), the Greek for difficulty breathing.
Acute (short-term) breathlessness comes on suddenly, while chronic (long-term) breathlessness develops gradually and may last for weeks, months or years. There are many causes of breathlessness and not all
of them are due to lung disease.
Causes of acute breathlessness
Lung-related
- Asthma
- Pulmonary embolism – clots in lung arteries originating from clots in deep leg veins
- Pneumothorax– collapsed lung
- An attack, or ‘exacerbation’, of chronic obstructive pulmonary disease (COPD)
- Pneumonia
- Obstruction of the large airway –the throat, voice box and so on
Heart-related
- Pulmonary oedema (fluid in the lungs) –heart failure
- Myocardial infarction – heart attack
- Arrhythmia – abnormal heart rhythm
- Pericardial effusion – fluid between the two coats of the heart
Other
- Pain
- Diabetes, if it is not controlled
- Drugs – an aspirin overdose, for example
- Injury to the large airway
- Acute blood loss
- Hyperventilation or panic attack
- Altitude sickness
Causes of chronic breathlessness
Lung-related
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Collapse of part of the lung
- Interstitial lung disease – widespread inflammation or scarring of the gas exchanging part of the lung (the alveoli)
- Allergic alveolitis– an allergic lung reaction to certain dusts that are inhaled
- Industrial or occupational lung diseases – asbestosis, for example, which is caused by exposure to asbestos
- Pleural effusion – fluid around the lungs
- Pulmonary emboli – blood clots
- Bronchiectasis– a disease of scarring and distortion of the bronchial tubes leading to a build-up of phlegm and chronic coughing
Heart-related
- Cardiomyopathy/myocarditis – disease of heart muscle
- Heart valve problems
- Arrhythmia – abnormal heart rhythm
Other
- Lack of physical fitness
- Obesity
- Anaemia – a condition related to the blood
- Muscular dystrophy or myasthenia gravis – diseases causing muscle weakness
- Thyroid disease – an over or underactive thyroid
Clues to what is causing your breathlessness
The description that you give of your breathlessness is very important in making the correct diagnosis. Your doctor will then examine you, concentrating on your heart and lungs.
- Breathlessness that comes and goes, especially if accompanied by wheezing, could be due to asthma. The relationship to any exposure to animals, pollens or some dusts or fumes at work can help identify the trigger. Intermittent breathlessness can also be due to irregularities of heart rate.
- For COPD, there will usually be a history of persistent, gradually increasing breathlessness, with or without a cough, in a smoker over the age of 35. The history and the results of simple breathing tests can generally distinguish between asthma and COPD.
- Knowing that you have had a clot in the leg veins after a long flight, in pregnancy or after an operation might suggest that a piece of clot has broken off and travelled to the lungs, producing sudden breathlessness – a pulmonary embolism.
- However, sudden breathlessness in a young, otherwise fit person, often associated with sharp chest pain, might suggest a collapsed lung.
- Pneumonia is an inflammation of one or both lungs, which is usually caused by an infection. As well as breathlessness, symptoms can include fever, cough and chest pain.
- Obstruction of a large airway is associated with characteristic sounds when your doctor listens to your chest with a stethoscope.
- Gradually increasing breathlessness and ‘crackling’ noises in both lungs suggest a problem with the gas exchanging part of the lung (the alveoli). This could indicate interstitial lung disease or, if you have a history of exposure to asbestos, it may be due to asbestosis.
- If breathlessness is due to heart problems, there may also be crackling noises in the lungs or palpitations associated with an abnormal heart rate or rhythm or a heart murmur.
Questions your doctor should ask you to help diagnosis
- How long have you been breathless and how quickly did it come on?
- Does it come and go or is it there all the time?
- Is there any pattern to the breathlessness?
- Does it come on at any particular time of day?
- Does it come on or get worse when you lie flat?
- Do you smoke?
- What is your job?
- Is your breathlessness related to certain times at work?
- Does anything bring it on? For example, pollen, pets or medication?
- Do you have a history of heart, lung or thyroid disease or of anaemia?
What tests might be necessary?
A chest X-ray is needed to confirm pneumonia, a collapsed lung or a pleural effusion.
Although evidence of interstitial lung disease or bronchiectasis might be seen on a chest X-ray, usually a CT scan will be needed to confirm the diagnosis and the extent of the problem.
Blood clots in the lung can also be diagnosed with special scans of the lungs, while scans of leg veins might identify the source of these clots.
Different patterns of abnormalities seen on breathing tests will help your doctor to distinguish obstruction to airflow through the breathing tubes – as in asthma or COPD – from a problem in the gas exchanging part of the lung, such as interstitial lung disease.
If a heart problem is suspected, a heart trace (ECG), an echocardiogram and a visit to a heart specialist (cardiologist) might be necessary. Blood tests will show whether either anaemia or thyroid disease is the cause.
Management of the causes of breathlessness
Once the cause is known, breathlessness can be treated and it usually improves.
For asthma or COPD, inhaler doses might be increased or you might be given corticosteroid tablets.
It can be difficult to improve interstitial lung disease with medication. The exception is sarcoidosis, where medicines are often helpful.
Fluid around the lung, or a collapsed lung, can be treated in hospital. ‘Anticoagulant’ drugs are given for clots. For anaemia, medication is used to build up the blood or a blood transfusion is given. Thyroid disease can also be treated with medication.
For heart failure, treatment can improve the outflow of fluid via the kidneys and there are various medications to deal with heart rhythm problems.
If your breathlessness is due to panic or hyperventilation, treatment can be aimed at reducing anxiety and calming the breathing.
Management of breathlessness itself
Chronic breathlessness itself can be improved by regular exercise, as well as breathing control and relaxation exercises. Ask your doctor about a course of pulmonary rehabilitation, which will show you how to improve your exercise capacity and get the most out of your breathing.
Oxygen treatment is not suitable for everyone experiencing breathlessness. It is only helpful if your blood oxygen level is low. A respiratory specialist will be able to assess whether extra oxygen is a useful treatment for your condition. This could come in the form of long-term home oxygen treatment, via a concentrator, or portable oxygen treatment in small cylinders that are carried when you go out.
Some medications improve the sensation of breathlessness. They are very strong and might make you sleepy. They also have other side effects such as nausea and constipation. Because of this, they are used as a last resort and will be carefully monitored by your doctor.
Nutrition is also important. Being overweight makes breathing more difficult. Getting your weight to within the normal range for your height should improve your breathing.
However, some people lose weight as their breathlessness gets worse. Severe weight loss can weaken the muscles used for walking and for breathing, making breathlessness worse still. In these circumstances, it is important to try to build up your weight and muscle strength by eating nutritious food, rich in proteins and calories. Ask your nurse or dietician for more information.
How do we assess breathlessness?
The scale most commonly used by GPs and specialists to measure breathlessness is the Medical Research Council dyspnoea score.
0 No breathlessness
1 Breathless on vigorous exertion, such as running, swimming, cycling
2 Short of breath on hurrying or walking up slopes
3 Breathless on walking at normal pace on the flat – has to stop from time to time
4 Stopping for breath after walking about 100yds or for a few minutes on the level
5 Too breathless to leave the house
Code: FL35
Version: 2
Last medically reviewed: January 2012
Due for medical review: January 2014
For references call 020 7688 5555
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