Living with shortness of breath

Overview

Shortness of breath is an uncomfortable feeling of not getting enough air. It can be mild after exercise or so severe that resting does not help.

Yes, shortness of breath is very common and affects people of all ages. Many lung and heart conditions cause it, and it can also be a response to anxiety or physical deconditioning.

It can affect anyone, but you are more likely to experience it if you have asthma, COPD (chronic obstructive pulmonary disease), heart failure, anaemia, or a sedentary lifestyle.

Symptoms

Common symptoms

• Feeling breathless after light activity
• Wheezing or a noisy sound when breathing
• Tightness in the chest
• Coughing that lasts or worsens
• Feeling tired or unable to keep up with daily tasks

Symptoms in children

• Rapid breathing or breathing faster than usual
• Flaring of the nostrils
• Grunting sound with each breath
• Pulling in of the skin between the ribs with breathing
• Refusing to feed or difficulty feeding

Symptoms in older adults

• Confusion or being less alert than usual
• Fatigue with simple activities like dressing
• Increased breathlessness that limits walking distances
• Less typical chest discomfort, so breathlessness may be the main warning sign

Causes

Main causes

• Lung conditions such as asthma, COPD, pneumonia, or pulmonary embolism
• Heart conditions such as heart failure or heart rhythm problems
• Anaemia (low red blood cells)
• Anxiety or panic attacks
• Obesity or lack of physical fitness

Risk factors

• Smoking or long-term exposure to second-hand smoke
• Exposure to air pollution, dust, or chemical fumes
• Long-standing lung or heart disease
• A very sedentary lifestyle
• Being over the age of 65

When to see a doctor

See a doctor urgently if:

• New breathlessness that comes with a cough and fever
• Breathlessness that becomes worse over a few hours or days
• Coughing up blood
• Leg swelling together with breathlessness

Book a routine appointment if:

• Gradual onset of breathlessness with no clear reason
• Breathlessness that makes it hard to climb stairs or walk short distances
• Worsening of a known lung or heart condition despite treatment

Diagnosis

A healthcare provider will ask about your symptoms, medical history, and lifestyle. They will listen to your chest with a stethoscope and may check your oxygen level.

Tests that may be done

• Pulse oximetry – a small clip on your finger to measure oxygen in your blood
• Spirometry – breathing into a machine to test how well your lungs work
• Chest X-ray – to look for problems in your lungs or heart
• Blood tests – to check for anaemia or signs of infection
• Electrocardiogram (ECG) – a painless test to check your heart rhythm

What to expect at your appointment

You will likely be asked to breathe into a device or have blood drawn. These tests are usually painless and take less than an hour. The doctor will explain what they find and what the next steps are.

Treatment

Treatment focuses on the cause of your breathlessness. It may include medicines to open airways, oxygen therapy, or a structured program called pulmonary rehabilitation to improve your strength and breathing.

Self-care at home

• Practice pursed-lip breathing – breathe in slowly through your nose, purse your lips, and breathe out slowly through your mouth
• Pace yourself during activities – take breaks before you feel too breathless
• Sit in a comfortable, upright position, leaning slightly forward to make breathing easier
• Keep hydrated by sipping water
• Avoid smoke, strong scents, and dusty places

Medical treatments

Your healthcare team may prescribe inhaled medications to relax and open the airways, medicines to reduce inflammation, or oxygen therapy if your oxygen levels are low. They may also recommend pulmonary rehabilitation, which combines exercise, education, and breathing techniques. Always take medications exactly as prescribed and talk to your doctor before changing anything.

When is surgery considered?

In rare cases, surgery may be considered for an underlying cause like a heart valve problem or lung volume reduction for severe COPD. This is only suggested after thorough testing and discussion with a specialist.

Living with this condition

Plan your day so you have enough energy for activities. Put everyday items where you can reach them easily, and give yourself extra time for tasks. Use breathing techniques we talked about and rest when you need to.

Lifestyle tips

• If you smoke, ask your healthcare provider for help quitting
• Stay as active as you safely can – gentle activity helps build stamina
• Aim for a healthy weight to reduce pressure on your heart and lungs
• Get good-quality sleep and rest when tired
• Find ways to manage stress, such as mindfulness or talking to someone

Diet and exercise

Eating a balanced diet gives you energy and helps maintain a healthy weight. Gentle exercise like walking, seated leg lifts, or breathing exercises can improve your fitness. Always check with your healthcare provider before starting a new exercise routine.

Mental health and emotional wellbeing

Living with breathlessness can cause anxiety, fear, or low mood. It is important to talk about how you feel – anxiety can actually make breathlessness worse, so seeking help is good for both your body and mind.

Prevention

Not all causes of breathlessness can be prevented, but you can reduce your risk by staying active, avoiding smoking and second-hand smoke, managing long-term conditions like asthma or heart disease, and following your treatment plan.

Vaccines

Vaccinations against flu, COVID-19, and pneumonia can help prevent lung infections that may cause or worsen breathlessness.

Screening programmes

If you have a family history of heart disease or lung disease, or if you smoke, talk to your doctor about regular check-ups to catch any problems early.

Complications

If left untreated

• Low oxygen levels, which can affect the brain, heart, and other organs
• Falls due to dizziness or weakness
• Difficulty doing everyday tasks, leading to loss of independence
• Worsening of the underlying disease if not diagnosed and treated

Long-term outlook

Many people manage their breathlessness very well with the right treatment, learning new techniques, and small adjustments to daily life. It may take time, but you can still live a full and meaningful life.

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