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.

Anyone can feel puffed and out of breath after a burst of physical activity. But, if you experience breathlessness while you are resting you should see your doctor as it may be due to an underlying health condition.

Ways of managing breathlessness include medication, breathing techniques, changes in position and relaxation exercises.

What should I do if I feel very breathless?

  • Try to stay as calm as possible.
  • Call 111 if severe and sudden and with no obvious cause (ie, exercise).
  • Call your GP urgently otherwise.
  • Use your reliever inhaler or oxygen.
  • Follow the action plan written by your doctor or nurse.

What causes breathlessness?

When your body needs more oxygen, your breathing gets faster to get more oxygen from the air. This can make you feel breathless. It may feel uncomfortable and hard to get your breath, but breathlessness doesn’t damage your lungs.

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

Acute causes:

  • 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 the lung)
  • pulmonary oedema (fluid inside the lungs)
  • a heart problem such as heart failure where the heart doesn’t pump properly
  • anxiety can cause breathlessness, rapid heartbeat (palpitations), sweating and feelings of panic.

Chronic causes:

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

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.

How is breathlessness diagnosed?

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

  • 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
  • talk to you about having some tests.

How is breathlessness treated?            

Treatment will depend on what is causing your breathlessness. Your doctor may give you medication to help with breathlessness. These may be medications to treat pneumonia or other chest infection, wheezing, fluid build-up in the 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, such as: 

Breath control techniques

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

A simple breathing exercise to try:

  • Breathe in slowly for count of 3 1-2-3
  • Hold the breath for count of 3 1-2-3
  • Breathe out slowly for 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 on 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 which can help you feel more relaxed and calm. Read more about mindfulness.

Can breathlessness be prevented?

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 can help. This will strengthen your muscles and help 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 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.

Support

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

Learn more

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

References

Breathlessness Patient.info
Shortness of breath NHS choices

Reviewed By: Leanne Rhodes, ADHB (18 May 2017)