Breathlessness: when should I see a doctor?

While occasionally feeling short of breath is a healthy and normal human response, having difficulty breathing (also known as breathlessness) may be a sign of a serious condition.

Dr John Chinegwundoh, a highly-experienced Consultant Respiratory Physician, provides an expert insight into breathlessness, including when medical attention should be sought.

What might breathlessness be a sign of?

In most cases, it is natural to become breathless on significant exertion, as the lungs are encouraged to work harder to keep up with the body’s oxygen demands (particularly the needs of the large leg muscles.) However, if breathlessness develops with minimal or no exertion, then it is a worrying symptom and could be a sign of life-threatening conditions such as lung cancer, lung clots or pulmonary embolism. Other conditions include asthma, chronic obstructive pulmonary disease (COPD), heart failure and pulmonary fibrosis. Alternatively, breathlessness may also be a sign of anaemia, low fitness levels or be explained by obesity. In the present climate, breathlessness can be linked to a COVID-19 infection.

Why am I out of breath? How can I avoid this?

A person gets out of breath for many different reasons and this can come on very suddenly or occur more gradually. It reflects either the lungs struggling to keep up with the body’s oxygen demands or the heart failing to pump oxygen efficiently through the bloodstream. Low levels of red blood cells will also lead to the sensation of breathlessness.

To avoid getting out of breath, one must maintain a healthy weight and exercise regularly - even walking at a good pace on a frequent basis can help. Avoiding smoking will also help the lungs remain healthy. If you have conditions such as asthma, these should be treated effectively.

When should I seek medical attention regarding being out of breath?

If breathlessness is interfering with simple day-to-day activities or it comes on suddenly without warning, then medical attention should be sought. Breathing difficulties at night when trying to sleep is another trigger to see the doctor. If you are experiencing other symptoms such as unintentional weight loss, a persistent cough or swollen ankles, then a medical review is also warranted. If breathlessness has developed after a COVID-19 infection, then seeing a doctor is important to rule out certain complications.

How is the exact cause of breathlessness determined?

Generally, a medical practitioner can work out the cause of breathlessness by listening to a patient’s report of symptoms and by physically examining a patient. In some occasions, however, certain tests will need to be performed. These could include blood tests, a chest X-ray, lung function tests, a CT chest scan and an ultrasound of the heart (an echocardiogram).

How is breathlessness treated?

Treatment depends very much on the underlying cause. For some people, losing weight and increasing fitness levels may do the trick. In others, managing low red blood cell levels (anaemia) will be the solution.

Many causes of breathlessness will require specific medication to help the lungs or the heart to work more efficiently. One of the commonest lung treatments will involve breathing in medicine into the lungs via an inhaler device.

What are the main risk factors relating to breathlessness?

Age: from the mid-twenties the lungs lose a small amount of capacity, typically 30mls a year. Breathlessness may be a natural part of ageing and older individuals often have to pace themselves so that their lungs can cope.

Obesity: carrying excess weight is linked to breathlessness in many ways as there is a direct squashing effect on the lungs, which makes it harder for them to expand. The body also makes certain inflammatory proteins in higher quantities in people who are overweight that appear to affect respiratory function. In addition, poor quality sleep linked to a high body mass index leads to fatigue, and sometimes weakness, of the breathing muscles. Heart disease is also more common in people who are obese. Finally, there are greater oxygen demands to move a larger body from point A to point B.

Smoking: leads to specific lung diseases like COPD and lung cancer. It also worsens asthma control, with asthmatics who smoke requiring higher doses of medications and suffering more frequent asthma attacks. People who smoke produce carbon monoxide, which reduces the oxygen-carrying ability of the red blood cells. They are also at a higher risk of heart disease.

Allergies: can cause a direct reduction in airflow through the nose, but often, allergic conditions can be linked to asthma, which impacts the lungs. A severe allergic reaction or anaphylaxis may cause swelling in the throat and the breathing tubes, which can be fatal.

Recent surgery, immobility and long-haul flights are all risk factors for the development of clots on the lungs or pulmonary emboli.

Premature birth: can lead to problems later in life as the lungs may not develop to their full potential. This is particularly noticeable if high levels of oxygen were needed in early life.

Curvature of the spine such as scoliosis or kyphosis can restrict the ability of the lungs to expand normally. The breathlessness that often comes later in life as part of the natural ageing process also leads to smaller lung capacity, which exacerbates the restriction from the spinal abnormality.

If you experience breathlessness, or have done so in the past, and would like to seek expert assessment for it, make sure to visit Dr Chinegwundoh’s Top Doctors profile today.