Breathlessness

Also known as shortness of breath or dyspnoea

The uncomfortable sensation of having difficulty breathing and feeling short of breath is known as breathlessness. The medical term for this is dyspnoea.

Key points

  1. Anyone can feel puffed and out of breath after a burst of physical activity. But if you experience breathlessness while you are resting, see your doctor as it may be due to an underlying health condition.
  2. There are many causes of breathlessness. Some are not serious, but some are. 
  3. Treatment will depend on what is causing your breathlessness.
  4. Ways of managing breathlessness include medication, breathing techniques, changes in position and relaxation exercises.
  5. See your GP if you have breathlessness to make sure it is nothing serious.

What are the symptoms of breathlessness?

Symptoms can range from mild shortness of breath to very fast gasping breaths. You may also feel:

  • dizzy
  • chest discomfort and/or tightness
  • anxious or scared.

Seek immediate medical attention from the nearest emergency department or call 111 if you or someone you care for has the following symptoms:

  • sudden breathlessness that develops over hours or days
  • you feel short of breath at rest
  • severe breathlessness causing inability to speak in full sentences
  • confusion or drowsiness
  • your chest feels tight or having sudden chest pain at rest.

If you have an underlying lung condition that makes you breathless from time to time, such as asthma or COPD, use your reliever inhaler immediately and follow the action plan written by your doctor or nurse. Read more about asthma and COPD.

If your breathlessness has come on slowly and has been happening for more than a month, it is a good idea to see your GP and get checked to make sure it is nothing serious.

COVID-19 pandemic

If you have COVID-19 symptoms (fever, coughing, sore throat, difficulty breathing), call your GP clinic or phone the dedicated Healthline COVID-19 number (for free) on 0800 358 5453 (+64 9 358 5453 for international SIMs). The 0800 number operates 24/7 and interpreters are available. They will advise whether you need to have a COVID-19 test, based on whether you are at high risk of having been exposed to the virus. Read more about who should have a COVID-19 test.

In all cases, do not go to a medical clinic without phoning first – you may infect other people. If it is an emergency, phone 111 or go to your nearest hospital emergency department.

What are the causes of breathlessness?

There are many causes of breathlessness. It may come and go quickly (acute) or may come on slowly and last longer (chronic).

Acute causes include the following:

  • Asthma – a respiratory condition that can cause wheezing and difficulty breathing. An acute attack may be triggered by a chest infection or hay fever.
  • COPD – a long-term condition that causes breathlessness and cough. Symptoms made worse by chest infections.
  • Pneumonia (a severe chest infection) will cause breathlessness.
  • Pneumothorax (a collapsed lung).
  • Pulmonary embolism (blood clot in your lung).
  • Pulmonary oedema (fluid inside your lungs).
  • A heart problem such as heart attack or heart failure where your heart doesn’t pump properly.
  • Anxiety can cause breathlessness, rapid heartbeat (palpitations), sweating and feelings of panic.

Chronic causes include the following:

  • COPD – a respiratory condition usually caused by smoking.
  • Asthma that is not well controlled.
  • Other lung conditions like bronchiectasis.
  • Heart failure – breathlessness and swollen ankles gradually worsen.
  • Heart rhythm problems, such as atrial fibrillation – this means blood isn’t pumped around your body properly so breathing becomes more rapid to try and get more oxygen into your lungs.
  • Anaemia (low iron levels in your blood) – this means there is not enough haemoglobin in your blood to transport sufficient oxygen around your body.
  • Being obese or not very fit.

How is breathlessness diagnosed?

To diagnose the underlying cause of your breathlessness, your doctor may ask you about the following:

  • How often it happens, how quickly it comes on and how long it lasts.
  • If anything causes you to become breathless or makes it worse.
  • If it happens at rest or with activity.
  • If you can sleep flat at night or if it gets worse lying down.
  • If you been unwell with a fever.
  • If you have been coughing any mucus or have any discomfort in your chest.

If you are known to have a condition that causes breathlessness, your doctor will review your medications and/or inhalers. They may ask you how you have been using them. Your doctor or nurse may explain how to use them to make sure they are working well.

Your doctor may also listen to your heart and lungs. If the cause of your breathlessness is not obvious from your history and examination, your doctor may talk to you about having some tests. These include:

How is breathlessness treated?            

Treatment will depend on what is causing your breathlessness. Your doctor may give you medication. This may be to treat pneumonia or other chest infection, wheezing, fluid build-up in your lungs or anxiety.

If you are a smoker, you will be strongly encouraged to stop. Losing weight if you are overweight will also help.

What can I do to help with ongoing (chronic) breathlessness?

There are a number of things you can try to help manage breathlessness. 

Breath control techniques

There are some breathing techniques and exercises that can help you control your breathing.

A simple breathing exercise to try is as follows:

  • Breathe in slowly for a count of 3 1-2-3.
  • Hold your breath for a count of 3 1-2-3.
  • Breathe out slowly for a count of 3 1-2-3.
  • Repeat 3 or 4 times until you start to feel relaxed.

Ask your doctor about referring you to a physiotherapist to learn about breathing techniques and exercises. You can also look for a physiotherapist with a respiratory interest: Find a physio (Physiotherapy NZ) 

Body position

Changing the position of your body can also help when you are feeling breathless. Try the following:

  • Put yourself in a position that supports your head and shoulders to relax comfortably.
  • Try a range of positions such as sitting or standing up tall, or leaning forward resting your elbows on your knees or a bench.
  • Rest, breathing slowly and gently, in the position that is most comfortable for you.

Relaxation and mindfulness exercises

Learning how to relax can help prevent the breathlessness/anxiety loop.

  • Feeling breathless can make you feel anxious and when you are anxious, your breathing tends to become more rapid and shallow.
  • This can make your feel more breathless, which in turn can increase your anxiety.
  • Learning and practising relaxation techniques can help you become calm and slow your breathing.
  • Mindfulness is a useful practice that can help you feel more relaxed and calm. Read more about mindfulness.

How can I prevent breathlessness?

Breathlessness can’t always be prevented but some things might help.

  • If you smoke, get help to stop.
  • If you are overweight, try to lose weight.
  • Exercise regularly. Even if you have a lung condition, exercise and pulmonary rehabilitation can help. It strengthens your muscles and helps you manage your daily activities. Being fit also improves your heart and lungs function, which helps to provide your body with the oxygen it needs. If you are struggling to exercise due to breathlessness, talk to your doctor as there may be an exercise/rehabilitation programme you can be referred to (depending on health condition). Read about pulmonary rehabilitation and green prescriptions.
  • If you are on medication for your breathing, make sure you take it as prescribed. If you are still getting symptoms see your doctor for a medication review.
  • Practice mindfulness and relaxation techniques.

What support is available with breathlessness?

Living with breathlessness can be frightening. It is also challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need.

Below are some support services and information for people affected by breathlessness and their family/whānau:

Support groups for people with a respiratory condition Asthma and Respiratory Foundation, NZ
Information about anxiety, depression and mindfulness Mental Health Foundation, NZ

Learn more

Breathlessness Cancer Society, NZ
A guide for patients with Chronic Obstructive Pulmonary Disease (COPD) and their carers Don’t Forget to Breathe, NZ
Your health – for people with a respiratory condition Asthma and Respiratory Foundation, NZ
Information for family and carers Asthma and Respiratory Foundation, NZ
Supporting someone with breathlessness Supporting Breathlessness, UK

References

Credits: Health Navigator Editorial Team. Reviewed By: Leanne Rhodes, Respiratory Nurse Specialist, Auckland DHB Last reviewed: 08 Jul 2020