Shortness of breath
Shortness of breath is the feeling that there is not enough air: breathing turns fast and shallow, you find yourself gulping for it, stopping in the middle of…
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Medicines commonly prescribed for Shortness of breath
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: PULMONARY INHALATION, 400 micrograms budesonideActive substance: budesonideManufacturer: Viatris Healthcare LimitedPrescription requiredDosage form: PULMONARY INHALATION, 400 mcg/doseActive substance: budesonideManufacturer: Orion CorporationPrescription requiredDosage form: PULMONARY INHALATION, 500 mgActive substance: salbutamolManufacturer: Glaxosmithkline S.A.Prescription required
Shortness of breath is the feeling that there is not enough air: breathing turns fast and shallow, you find yourself gulping for it, stopping in the middle of a sentence or halfway up a flight of stairs. A healthy person is out of breath after running and breathing normally a minute later — that is not a symptom. It becomes a symptom when it turns up during effort you used to manage comfortably, or when it turns up at rest. And the first thing worth understanding about it: how quickly it started matters more than how badly you feel short of air.
Sudden breathlessness is an emergency
If breathing has become difficult suddenly — over minutes, or over an hour or two — and this has never happened before, call an ambulance: the single European number 112, or your local emergency number. Minutes count here. Do not wait until morning, do not test whether it settles on its own, and do not drive yourself.
Call straight away if any of the following comes with the breathlessness:
- pain, pressure, burning or heaviness in the chest, especially spreading to the arm, back, neck, jaw or under the shoulder blade;
- chest pain that gets worse when you breathe in, together with a racing heartbeat;
- lips, face or fingertips turning blue or grey — on brown and black skin this shows up more clearly on the palms, under the nails and inside the mouth;
- you cannot finish a sentence and have to take a breath every two or three words;
- confusion, unusual drowsiness, a sense of impending disaster;
- swelling of the lips, tongue or throat, a rash, or wheeze after a medicine, a sting or food;
- breathlessness that began immediately after choking on something;
- bubbling breathing or pink frothy sputum.
While the ambulance is on its way, sit up, open a window and loosen tight clothing. If you have a reliever inhaler prescribed for you, use it. Have a list of the medicines you take ready — the crew will want it in the first minute.
What lies behind sudden breathlessness
All of these respond far better the earlier treatment starts, and nearly all of them move faster than the time it takes someone to decide to phone.
- Heart attack. Breathlessness can be its only sign, with no chest pain at all. That pattern is more common in women, in older people and in people with diabetes, so "my chest doesn't hurt" is no reason to relax.
- Pulmonary embolism. Sudden breathlessness, chest pain that sharpens when you breathe in, a fast pulse, sometimes blood in the sputum or a faint. The risk is higher after surgery, a fracture, a plaster cast, a long flight or drive, during prolonged bed rest, in pregnancy and after birth, with cancer, while taking oestrogens, and if you have had a clot before. A swollen, tender calf on one side only is an important clue.
- Pneumothorax. Abrupt pain in one side of the chest with breathlessness, often out of the blue in tall, slim young people, and also in anyone who already has a lung condition.
- A severe asthma attack, where the inhaler does not help or helps for only a few minutes.
- Pulmonary oedema from decompensated heart failure: suffocating breathlessness, being unable to lie flat, bubbling in the chest.
- Anaphylaxis — rapid swelling, a rash and a drop in blood pressure after a medicine, food or a sting.
- A foreign body in the airway, particularly in small children and older people.
- Severe pneumonia with high temperature, shivering and fast breathing.
Breathlessness that builds over weeks
Slow breathlessness seems less dangerous only because there is time to get used to it: you stop carrying bags, start walking more slowly and put it down to age. Meanwhile, what sits behind it are conditions that can be treated, and the sooner the better.
- Heart failure. Swollen ankles and legs that worsen through the day; not being able to sleep without two or three pillows; waking at night short of air an hour or two after falling asleep; rapid weight gain over a few days.
- Chronic obstructive pulmonary disease. Years of smoking, a morning cough with phlegm, breathlessness first on hills and later on the flat. Breathlessness in a smoker over forty is a direct reason to arrange spirometry.
- Anaemia. Pallor, weakness, palpitations, ringing in the ears. In women a common cause is heavy periods; in men and in older people, hidden blood loss from the stomach or bowel needs looking for.
- Repeated small clots in the lungs. Breathlessness creeps up, and there may be no single dramatic episode at all.
- Lung cancer. A cough lasting more than three weeks, blood in the sputum, weight loss, a hoarse voice, chest pain.
- Diseases of the lung tissue — fibrosis and other interstitial conditions: a dry cough and breathlessness that worsen over months.
- Fluid around the lung, thyroid disease, obesity, and weakness of the breathing muscles in neurological illness.
Breathlessness in a child
Children hold on for a long time and then tire very quickly, so what counts here is how the child is breathing rather than what they say about how they feel. Call an ambulance if a child:
- is breathing very fast, grunting or moaning as they breathe out;
- is sucking in the spaces between the ribs, the hollow above the breastbone or the tummy under the ribs, with the nostrils flaring;
- has lips, face or palms turning blue or grey;
- is limp, floppy, not responding as usual, with the head lolling and the eyes not focusing;
- cannot talk, eat or drink because of the breathlessness;
- has become confused, unusually agitated or is crying without stopping;
- is a baby who has pauses in breathing.
Breathlessness with wheeze and a barking cough at night, breathlessness after a child has been playing with small objects, and breathlessness with a high temperature all need to be seen the same day, even if the child looks well between episodes.
When it really is anxiety or extra weight
Panic attacks genuinely do produce a feeling of not getting enough air, and a very convincing one. But it has its own shape: the attack builds over minutes, brings tingling around the mouth and in the fingers, dizziness, trembling and fear, lasts a few minutes and passes leaving nothing behind, and in between the person copes with exertion exactly as usual. Extra weight and being out of condition are a real cause too — only they build over months and years, not over a week.
The trouble is that both explanations are too convenient. They are often handed out before any investigation, so a heart attack or a clot in someone with an anxiety disorder or a large body weight gets the same label. The correct order is the other way round: rule out the heart and the lungs first, and talk about anxiety afterwards. If the breathlessness has changed — coming on sooner than it used to, or waking you at night for the first time — it needs an explanation whatever diagnosis you were given before.
In asthma and COPD, worsening is counted by the inhaler
The commonest mistake in these conditions is judging yourself by how you feel. Feelings mislead: constant shortage of air becomes familiar and gets accepted as your normal. Counting how much medicine you need is far more reliable.
Get medical advice without waiting for your routine appointment if:
- you are using the reliever inhaler more often than is usual for you;
- it works less well or the relief does not last;
- you have started waking at night with cough, wheeze or breathlessness;
- you are having to give up ordinary things — work, a walk, the stairs;
- there is more phlegm, it has changed colour, or a temperature has appeared.
If the inhaler has stopped working altogether, that is an ambulance call rather than an appointment. Anyone with a written action plan for flare-ups should keep it where the people around them will find it too.
What matters when you describe it to a doctor
Working out breathlessness starts with the circumstances in which it appeared, so have your answers ready: how quickly it came on, exactly what effort brings it on now and what brought it on six months ago, whether it depends on your position, and what comes with it — cough, swelling, pain, fever, palpitations. Note separately any operations, injuries, plaster casts, long flights or drives in the past few weeks, your smoking and for how long, dusts and fumes at work, every medicine you take, and any known heart, lung, kidney or thyroid disease.
From there the doctor follows what is found. Usually that means examination with listening to the chest and heart, measuring the oxygen level in the blood, an electrocardiogram, a chest X-ray or CT scan, a blood count, spirometry, an echocardiogram, and, where a clot is suspected, specific imaging of the lung vessels. It helps to bring a simple diary: how many steps or metres you can manage before you have to stop. That is the easiest way to show the trend in numbers.
Online consultation
An online appointment suits breathlessness that is building gradually, when the question is what to do next: which tests to arrange, which specialist to see, what the results and images you already have actually mean, and how to handle your inhalers and prescribed medicines. The doctor will go through your history, help separate a cardiac cause from a lung one, and set out a clear plan of steps.
If breathlessness has come on suddenly and goes with chest pain, blue lips or confusion, no online consultation replaces an ambulance. Call one first and speak to a doctor afterwards.
This material is for information only and does not replace medical advice.
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