Shortness of breath: causes and next steps

Why do people get short of breath?

NHS inform lists asthma attacks, pneumonia and heart failure among the likely causes of sudden breathlessness. NHS inform also lists a severe allergic reaction, a collapsed lung and a blood clot in the lung as possible causes of sudden breathlessness. A collapsed lung, or pneumothorax, is a partial collapse of the lung caused by a small tear in the lung surface.

The NHS lists several possible causes of breathlessness, including COPD, scarring of the lungs, heart failure, asthma, chest infections and being overweight. In heart failure, fluid builds up in the lungs and makes breathing harder.

What do asthma, COPD, heart failure and a lung clot look like?

Sudden breathlessness could be an asthma attack, which makes it difficult to move air in and out of the airways. The NHS lists breathlessness as the most common symptom of heart failure; it may happen after activity or at rest, may be worse when lying down, and may wake a person at night. It lists tiredness, swollen ankles and legs, and feeling lightheaded or fainting as other heart failure symptoms. An NHS trust leaflet says the most common symptom of a pulmonary embolism is breathlessness, with chest pain that is worse on breathing or coughing, and it also lists cough and fever.

When is breathlessness an emergency?

NHS inform says to call 999 or go to A&E for severe difficulty breathing, such as being unable to speak without pausing for breath. The NHS says chest tightness or heaviness, or pain that spreads to the arms, back, neck or jaw, is also a reason to call 999 or go to A&E. The NHS adds sudden confusion, or lips or skin turning pale, blue or grey, to the signs for calling 999 or going to A&E. NHS 111 Wales advises that a person should not drive themselves to A&E but should ask someone to take them or call an ambulance.

When should breathlessness be seen urgently or soon?

The NHS says to contact NHS 111 for difficulty breathing, feeling or being sick, coughing up blood, or pain or swelling in one leg. NHS inform advises contacting the GP practice if breathlessness is new or unexplained. The NHS advises seeing a GP if breathlessness has lasted longer than a month, gets worse with normal activity or when lying down, or comes with swollen ankles.

What does the GP ask about and test?

NHS inform's guidance asks whether breathlessness came on suddenly or slowly and whether anything triggered it, such as exercise. An NHS England pathway for persistent breathlessness lists an ECG, a chest X-ray and spirometry among the first-line tests. Spirometry is a breathing test that measures how much air a person can blow out and how fast. The same pathway says an ECG showing atrial fibrillation with breathlessness should prompt a heart specialist assessment, including an echocardiogram.

How is breathlessness treated?

Treatment depends on the cause. For COPD, treatment usually involves relieving symptoms with medicines such as inhalers, and pulmonary rehabilitation may help. Heart failure is managed with lifestyle changes and medicines or surgery. A blood clot in the lung can be treated with anticoagulants, which are drugs that thin the blood. NHS leaflets describe pursed-lip breathing as a technique that can help keep the airways open for longer and reduce the work of breathing, for example in COPD.