What causes Breathlessness

What causes Breathlessness

Everyone feels out of breath at some time. This information is for people who are feeling breathless and want to find out more.
Keeping active with a lung condition
It explains the possible causes of breathlessness and focuses on daily long-term, or chronic, breathlessness. It also explains how your doctor will diagnose what is causing you to get out of breath and things you can do to help yourself.
What is breathlessness?
Everyone feels out of breath at some time. You might get out of breath after heavy physical activity or exertion such as walking briskly up a steep hill or cycling fast. This is the sort of breathlessness you might expect and you can control.
This information is about being breathless when you find it unexpectedly difficult or uncomfortable to breathe – breathlessness that you don’t feel you can control.
Whether it comes out of the blue or is there every day, it can be very frightening. Anyone who gets out of breath without meaning to will feel anxious. Some people can feel embarrassed. As a result, they might change their behaviour and reduce their levels of activity. That actually makes the problem worse. Sometimes people don't tell their doctor or nurse about feeling out of breath because they feel responsible and don’t realise there is help available.
If you are breathless doing everyday activities, taking longer to do things or even avoiding doing things because you get out of breath, it’s time to go to see your doctor.
The good news is that as well as treating the underlying causes of breathlessness, there are various ways you and your health care professionals can help you to take charge of it so you can get the most out of life.
Health care professionals sometimes refer to breathlessness as dyspnoea.
Acute, or short-term, breathlessness can come on suddenly. It usually requires immediate testing or treatment. In some cases, when there is a flare-up of an underlying condition such as asthma, chronic obstructive pulmonary disease (COPD) or heart failure, this can include starting treatment yourself following an action plan agreed with your doctor or nurse.
This information is mainly about the daily long-term breathlessness that health professionals call chronic. It often develops gradually and lasts for weeks, months or years.
What causes breathlessness?
Feeling out of breath is a symptom. There are many underlying causes of breathlessness and not all of them are due to problems in your lungs.
What causes acute breathlessness?
If your breathlessness is acute – it comes on suddenly or it is short-term or comes and goes – you should act quickly. You will recover better the sooner you get treatment.
The more common causes of this sort of breathlessness are:
a flare-up of asthma. You might feel your chest is tight or feel you are wheezing rather than being short of breath.
a flare-up of COPD. You might feel more out of breath and tired than normal and your usual ways to control your breathlessness don’t work so well.
a pulmonary embolism. This is when you have clots in your lung arteries that have travelled from other parts of your body, usually your legs or arms. These clots can be very small and cause acute breathlessness. More clots can get released over a long time and cause your feeling of breathlessness to get worse, and eventually you might have daily long-term breathlessness.
lung infections such as pneumonia and bronchitis.
pneumothorax also called collapsed lung.
pulmonary oedema or effusion or fluid in your lungs. This might be due to the failure of your heart to pump fluid around efficiently or due to liver disease, cancer or infection. It can also cause long-term breathlessness but this can be reversed once the cause is known.
a heart attack also called a coronary artery thrombosis.
cardiac arrhythmia. This is an abnormal heart rhythm. You might feel your heart misses beats or you might experience palpitations.
hyperventilation or a panic attack.

As long as it works, we all take breathing for granted. I am now aware of every breath I take and of its own quality. I have a great group of professionals around to help me and I am well supported by my family." Chris, 69, was diagnosed with COPD eight years ago.
What causes daily, long-term breathlessness?
The conditions that cause long-term breathlessness can often be treated, although some cannot be fully reversed. With the appropriate support, you can learn to control your breathlessness, allowing you to live your life better. Conditions that cause long-term breathlessness include:
chronic obstructive pulmonary disease (COPD)
heart failure. This can be due to problems with the rhythm, valves or cardiac muscles of your heart.
interstitial lung disease (ILD), including idiopathic pulmonary fibrosis (IPF). These are conditions where inflammation or scar tissue builds up in your lungs.
allergic alveolitis, which is an allergic lung reaction to certain dusts you breathe in.
industrial or occupational lung diseases such as asbestosis, which is caused by being exposed to asbestos.
bronchiectasis. This is when your bronchial tubes are scarred and distorted leading to a build-up of phlegm and chronic coughing.
muscular dystrophy or myasthenia gravis, which causes muscle weakness.
anaemia and kidney disease.
being obese, lacking fitness, and feeling anxious or depressed can also cause you to feel short of breath. You might often have these issues alongside other conditions. Treating them is a vital part of treating your breathlessness.
What will happen when I see my doctor?
You may not actually feel out of breath when you see your doctor as you will be sitting down and may have only walked a short distance. So it is important to think about how you will describe your breathlessness or bring someone with you who can help.
Tip: if you have a phone with a camera, you could record the sort of activities that cause your breathlessness so you can show your doctor what it looks or sounds like.
Your doctor should ask you what you would like to get out of your first appointment. If they don't, let them know and agree what is possible in the time you have together.
Getting a diagnosis for daily long-term breathlessness can take some time as all possible causes will be considered. Your doctor or other health care professional might need to ask you to take repeated tests and to try various treatments before they can be sure of the cause. It is also likely that there may be a number of conditions and factors to get under control, so you and your health care professional should discuss setting priorities and goals.
Is it possible to measure breathlessness?
The scale most commonly used by GPs and specialists to measure breathlessness is the Medical Research Council (MRC) breathlessness score. When you see your health care professional, they should show you this chart when they ask how breathless you are. It works well because it shows what your breathlessness stops you from doing. Choose the grade that describes you when you are at your best.
It is also important to say what you used to be able to do; what people of your age around you do that you think you should be able to do, and what your personal goals are for your day-to-day activity. Use local landmarks such as bus stops, shops and hills when you talk to your GP or practice nurse as this is a useful record to have in your notes. As they are local your description will mean something to them.
You might currently have one cause of daily breathlessness, but it’s important to recognise that you might develop other causes over time. If things change, it is important to discuss with your health professional whether anything else might be going on that could also be treated.