Breathlessness

Breathlessness that is new, or that is getting worse, is one of the symptoms most worth taking seriously — and one of the easiest to explain away. People put it down to age, to weight, to being out of practice. Sometimes that is right. Often there is a specific cause that can be treated, and finding it early changes how much lung function you keep.

The useful question is not "am I breathless?" but "what can I no longer do that I could do last year?" Climbing to the first floor without stopping. Walking to the market at your usual pace. Carrying a bag up the stairs. A change in that is the thing to report.

When it is an emergency

Breathlessness that comes on suddenly — over minutes or hours rather than weeks — is different from breathlessness that has crept up. Sudden breathlessness can mean a clot on the lung, a collapsed lung, a severe asthma attack or a heart problem. Those need an emergency department the same hour, not an appointment. The red-flag list above is the one to act on.

The common causes

Asthma. Asthma causes breathlessness that comes and goes, often with wheeze, cough and chest tightness, worse at night or with exercise, dust, smoke or cold air. It responds well to the right inhaler.

COPD. COPD causes breathlessness that is steadily progressive, in a current or former smoker or someone with years of biomass-smoke or industrial-dust exposure. There is often a long-standing morning cough with phlegm. Treatment does not reverse it, but it substantially slows it and improves day-to-day capacity.

Anaemia. Low haemoglobin is a very common cause of breathlessness on exertion in India, particularly in women. A blood count costs little and is often the whole answer.

Heart problems. Breathlessness on lying flat, waking at night needing to sit up, or swelling of both ankles points towards the heart rather than the lungs. The two overlap, and the assessment has to consider both.

Interstitial lung disease. ILD causes slowly worsening breathlessness with a dry cough. It is easy to mistake for asthma early on, but it behaves differently and the treatment is entirely different, so distinguishing them matters.

Obesity and deconditioning. Weight and lack of exercise genuinely cause breathlessness. This is a reasonable conclusion to reach after the others have been excluded, not before.

Sleep apnea. Disturbed breathing at night causes daytime exhaustion that people describe as breathlessness. Worth thinking about if you snore and are sleepy by day.

Thyroid, kidney and anxiety. All can present with breathlessness. A proper assessment does not jump to the last of these.

How it is investigated

The pattern of your breathlessness points the way. Is it constant or episodic? Worse lying down, or on exertion? How quickly did it change? Any cough, wheeze, chest pain or ankle swelling?

Then, as indicated:

• Oxygen saturation, at rest and often after walking — a reading that falls on exertion is significant and easily missed when only measured sitting down.
• A chest X-ray.
• Spirometry with reversibility, and where ILD is suspected, full lung function with diffusion capacity, which measures how well oxygen crosses into the blood.
• Blood tests — haemoglobin, thyroid, kidney function.
• An ECG and echocardiogram where the heart is in question.
• A CT scan where the X-ray or lung function raises a specific question.

What you can do before the appointment

Note what you can no longer do, and when it changed. If you have a pulse oximeter, record your reading at rest and again after walking briskly for a few minutes. Bring your medicine list and any previous blood reports, X-rays or echo reports — comparison over time is extremely useful.

Breathlessness with a named cause is usually a treatable problem. The risk is in accepting it as inevitable.