Breathlessness and Difficulty Breathing | Causes and Treatment (2023)

What is breathlessness?

If you have breathlessness, 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.

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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 the 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.

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(Video) Dyspnea - Difficulty Breathing, Uncomfortable breathing, breathlessness, Common causes

What investigations will be advised?

The healthcare professional will want to know more about your breathlessness:

  • 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 high temperature (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. They 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, for an underactive thyroid gland and for heart failure. Further tests of your heart and lungs may be necessary.

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Causes of breathlessness

Short-term/recent (acute) breathlessness
This may 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 become more breathless. You feel ill, have a high temperature (fever) and cough with greenish phlegm (sputum).
  • COVID-19 - may cause breathlessness that develops over a few days.
  • Chronic obstructive pulmonary disease (COPD)- a long-term lung condition causing breathlessness and cough. The airways become inflamed and narrowed. It may become 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.
  • Some medicines may cause breathlessness, especially if you already have a condition that causes breathlessness. For example, taking a beta-blocker (such as propranolol) or aspirin may cause breathlessness (if you have asthma).
  • 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 becoming 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 and swollen ankles - worse on lying down. It affects elderly people usually. It is due to the heart pumping inefficiently.
  • Heart rhythm problems - for example, an 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.

Are there any treatments for breathlessness?

Treatment will depend on the likely cause of your breathlessness. You will be strongly encouraged to stop smoking if you are a smoker. It will also help if you lose weight if you are overweight.

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.

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What can you do if you feel very breathless?

  • Try to keep calm.
  • Call 999/112/911 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 can you do to help ongoing (chronic) breathlessness?

There are some breathing control techniques that can help to reduce breathlessness. Examples include:

  • Relaxed, slow, deep breathing: breathe in gently through your nose and breathe out through your nose and mouth. Try to stay feeling relaxed and calm.
  • Paced breathing: this may help when you are walking or climbing stairs. Try to breathe in rhythm with your steps at a speed you find comfortable.
  • Controlled breathing. This involves using your diaphragm and lower chest muscles to breathe instead of your upper chest and shoulder muscles. Breathe gently and keep your shoulders and upper chest muscles relaxed.

Use different comfortable seating and standing positions when you feel breathless. Different positions suit different people but examples include:

  • When standing up, lean from the hips with your forearms resting on something at a comfortable height, such as a chair or kitchen work surface.
  • When standing or walking, put your hands on your hips or in your pockets.
  • When sitting, lean forwards, resting your forearms on your knees, on the arms of a chair, or on a table.

Arrange the things you use every day to make sure they are easy to reach. Try to stay active but take a rest when you feel breathless and then start again.

How can I avoid breathlessness?

You will need to find the underlying cause and try to address it if possible. Don't smoke, or if you do smoke, 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.

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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 become more and more breathless. Some people who are breathless will need oxygen.


What is the treatment for breathing difficulties? ›

Medications are also important in treating breathing problems. Oral or nasal allergy drugs such as antihistamines and decongestants may make it easier to breathe. Inhaled steroids can help. These drugs reduce inflammation in your airways.

What can a doctor do for shortness of breath? ›

Your doctor may prescribe one of the following medications, depending on the underlying cause of the dyspnea:
  • Bronchodilators to open airways.
  • Steroids to reduce swelling.
  • Pain medications.

How do I know if my shortness of breath is serious? ›

Seek emergency medical care if your shortness of breath is accompanied by chest pain, fainting, nausea, a bluish tinge to lips or nails, or a change in mental alertness — as these may be signs of a heart attack or pulmonary embolism.

What is the most common cause of shortness of breath? ›

Most cases of shortness of breath are due to heart or lung conditions. Your heart and lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing.

What are the three types of shortness of breath? ›

They include:
  • Orthopnea, when you feel short of breath when you lie down. ...
  • A similar condition called paroxysmal nocturnal dyspnea can make you feel so short of breath that you wake up in the middle of the night. ...
  • Trepopnea is a kind of dyspnea that happens when you lie on a certain side.
Aug 28, 2022

How do I know if my shortness of breath is heart related? ›

If shortness of breath happens when you're clearly not exerting yourself, when you're doing something you normally could do without feeling winded, or comes on suddenly, those are warning signs that a heart issue could potentially be to blame.

Does shortness of breath ever go away? ›

Treatment for shortness of breath depends on its cause. If the cause is your lungs or airways, your health care provider may give you medication. If it's because of anemia, you may need iron supplements. Most people begin to feel better after the diagnosis is clear.

Should I go to urgent care for shortness of breath? ›

Shortness of breath is a red-alert symptom. If you experience shortness of breath that is so severe that it interferes with activities of daily living or function, call 911 for an ambulance or have someone drive you to the ER immediately.

What kind of doctor should I see for shortness of breath? ›

A pulmonologist is a doctor who specializes in lung conditions. A pulmonologist diagnoses and treats diseases of the respiratory system. You might hear these healthcare providers called lung doctors, lung specialists or chest doctors.

What lung tests are done for shortness of breath? ›

Spirometry is the most common type of pulmonary function or breathing test. This test measures how much air you can breathe in and out of your lungs, as well as how easily and fast you can the blow the air out of your lungs. Your doctor may order spirometry if you have wheezing, shortness of breath, or a cough.

What stage of heart failure is shortness of breath? ›

Stage 2 of Congestive Heart Failure

Stage two of congestive heart failure will produce symptoms such as fatigue, shortness of breath, or heart palpitations after you participate in physical activity. As with stage one, lifestyle changes and certain medication can help improve your quality of life.

Why am I unable to take a full breath? ›

Shortness of breath is often a symptom of heart and lung problems. But it can also be a sign of other conditions like asthma, allergies or anxiety. Intense exercise or having a cold can also make you feel breathless.

What illness can cause shortness of breath? ›

Causes of long-term breathlessness

poorly controlled asthma. chronic obstructive pulmonary disease (COPD) – permanent damage to the lungs usually caused by years of smoking. anaemia – a low level of oxygen in the blood caused by a lack of red blood cells or haemoglobin (the part of red blood cells that carries oxygen)

What is the difference between shortness of breath and breathlessness? ›

What is breathlessness? If you have breathlessness, 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).

What is the difference between shortness of breath and difficulty breathing? ›

Being short of breath isn't the same thing as having trouble breathing. When you're having difficulty breathing normally, you might feel like: you can't completely inhale or exhale. your throat or chest are closing up or it feels like there's a squeezing sensation around them.

Does shortness of breath always mean heart failure? ›

Or if your heart isn't working as well as it should, this could cause a build-up of fluid in the lungs, making it difficult to breathe. Other conditions, including anxiety, asthma, a blood clot in the lungs, cancer, or a chest infection like pneumonia, can also lead to shortness of breath.

Can a blocked artery cause shortness of breath? ›

When the coronary arteries narrow, the heart may not get enough blood when it needs it most — like when exercising. This can cause chest pain (angina) or shortness of breath.

Why do I feel short of breath but oxygen levels normal? ›

Shortness of breath does not equal saturation (SaO2%)

In other words, your level of dyspnea, or air hunger, does not always correlate with your oxygen saturation. This means that you can be short of breath, even extremely short of breath, even in the presence of normal oxygen saturation.

Why am I out of breath when I walk? ›

People can experience shortness of breath while walking for a number of reasons. Sometimes, this occurs as a result of conditions such as anxiety, asthma, or obesity. Less commonly, shortness of breath signals a more serious underlying medical condition.

What is the best sleeping position for breathing problems? ›

Lying on your back can make it harder to breathe. Changing your position regularly (every 30 minutes to 2 hours) helps to move the air through all of your lungs. Try lying on your tummy, both sides, and sitting upright.

What are the stages of shortness of breath? ›

GradeDegree of dyspnea
2dyspnea when walking up an incline or hurrying on the level
3walks slower than most on the level, or stops after 15 minutes of walking on the level
4stops after a few minutes of walking on the level
5with minimal activity such as getting dressed, too dyspneic to leave the house
1 more row

Can shortness of breath be treated with medication? ›

Depending on the cause, doctors can treat shortness of breath in many ways. For infections or conditions where the airways of the lungs are swollen or inflamed, they may prescribe bronchodilator inhalers or steroids.

What is the best breathing treatment? ›

Nebulizers and inhalers are usually very effective at treating breathing problems. Inhalers are just as effective as nebulizers if the inhaler is used correctly.

What medication opens airways in the lungs? ›

Types of bronchodilator. The 3 most widely used bronchodilators are: beta-2 agonists – like salbutamol, salmeterol, formoterol and vilanterol. anticholinergics – like ipratropium, tiotropium, aclidinium and glycopyrronium.

When should you go to the ER for a breathing treatment? ›

Signs of a Breathing Emergency

Additionally, please head to the ER if any of the following symptoms accompany your shortness of breath: Chest pain. Dizziness or loss of consciousness. Pain that spreads or radiates to your arms, neck, jaw, or back.

Will a nebulizer help with shortness of breath? ›

Nebulizer Use

Nebulizer treatment relaxes the breathing muscles and permits air to flow more easily in and out of the lungs. It also helps to loosen mucous in the lungs. Both of these benefits of nebulizer treatment help to decrease and prevent wheezing, shortness of breath, coughing, and tightness in the chest.


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