What’s making you breathless?
Being short of breath is a normal physiological response, and can also be a sign that something’s wrong – but how do you tell the difference? A Bupa doctor shares his advice with Abi Jackson
Breathlessness is something most of us experience, to some degree, on a regular basis; sweating it out at the gym, sprinting for a bus, lugging heavy shopping bags… Most of the time, it’s completely normal.
When you’re under strain – like during exercise – oxygen needs to be pumped around the body, and carbon dioxide removed, more quickly, and our lungs and hearts begin working harder. Generally, the fitter somebody is, the more efficient this process will be. Stress and anxiety can, however, elicit a similar response.
Getting out of breath isn’t always unpleasant – after a successful run or victorious game of squash, for instance, it can feel quite satisfying, as the endorphins surge.
But it can also feel extremely distressing, especially if accompanied by a tight or painful chest, or it happens when you’re not expecting it.
That doesn’t necessarily mean anything serious – even something as simple as a pulled or knotted muscle can make you feel as though your chest is being gripped. However, breathlessness can be a sign of a medical problem too.
“When I talk to patients, I tend to say there are four main reasons why they might be breathless,” says Dr Brian O’Connor, consultant in respiratory medicine at Bupa Cromwell Hospital.
“One; they’re unfit or overweight. Two; their heart isn’t working in some shape or form. Three; their lungs are compromised in some shape or form. Four; they’re either having a normal response to whatever stress they’re under, which could be physical or mental, or they could be having a non-normal stress response.”
Knowing what’s normal and what’s not, though, can sometimes be tricky.
“Most people would instinctively know when breathlessness is disproportionate to the stress they’ve put themselves under,” says O’Connor. “For example, walking up an escalator; at 18, I could hop, skip and jump to the top without really getting breathless, but three decades on, I can’t. Some of that’s down to the fact I’m older, the fact I’m overweight and unfit. I’m also mildly asthmatic.
“Even as a respiratory doctor, I cannot always distinguish between the breathlessness of being unfit and the breathlessness associated with my asthma, so it can be difficult.”
If you’re concerned, O’Connor advises going to see your doctor to have it checked, and sudden, acute breathlessness could be a medical emergency.
“Acute breathlessness is what we call a ‘red flag’ symptom and must be dealt with straight away, because it could be anything from a heart attack, a clot or collapsed lung, or an acute asthma attack,” he notes.
Here are some common causes of breathlessness…
:: ASTHMA
Asthma’s a very common, long-term condition which affects children and adults, with around 5.4 million people in the UK currently being treated. Inflammation of the airways leads to symptoms including a tight chest, coughing and wheezing (a whistling sound when you breathe), and difficulty breathing, often brought on by triggers like smoke, exercise, cold air, exposure to furry animals (such as cats, dogs and horses), house dust and pollen. Having an infection, like a cold, can also worsen symptoms.
It can be mild or serious, with asthma attacks – though rare – sometimes being fatal. There’s no cure but treatments can help keep symptoms under control.
“Breathlessness associated with asthma might occur during exercise, and can be difficult to distinguish,” says O’Connor. “But symptoms usually include chest pain and coughing and wheezing. Some patients complain of not being able to get enough air into their lungs.
“There are probably hundreds of people walking around with asthma, who don’t know they’ve got it, and it’s not causing them too much trouble in terms of everyday living. But if you are worried, go and see your doctor and get it checked.”
:: ANXIETY AND PANIC ATTACKS
Anxiety can contribute to breathlessness in multiple ways. Long-term stress and anxiety can impact physical health, and could be a factor in why you feel more breathless than usual, while panic attacks – an intense burst of anxiety – can lead to sudden rapid breathing and possible hyperventilation, often accompanied by chest pain, shaking, rapid heartbeat, dizziness and disorientation. It can be extremely frightening and people may fear they’re having a heart attack. This isn’t the case though and attacks will eventually pass. They can occur as a one-off, however, they can also be part of an ongoing anxiety disorder, and if this is the case it’s important to seek help and advice for coping with them.
O’Connor says: “A young, fit and healthy person who’s experiencing chest pains and shortness of breath is unlikely to have heart disease; they might be experiencing anxiety. Then again, people do panic when they experience severe shortness of breath, for instance if they’re having an asthma attack for the first time, and this can lead to secondary hyperventilation.”
Panic attacks can be difficult to talk about, but O’Connor stresses that they’re not at all a sign of psychological weakness. “We all have the potential or ability to panic when under pressure – it’s the flight or fright response, and everyone’s experienced a shock in our lives where we’ve had palpitations.”
:: HEART PROBLEMS
Sudden shortness of breath, especially if accompanied by chest pain which may radiate to the jaw, neck and arms, feeling weak and light-headed and overwhelmingly anxious, could be a heart attack, which occurs when the blood supply to the heart is suddenly blocked, often by a clot, and can lead to serious long term damage or death, so getting to hospital quickly is paramount.
Coronary heart disease is the biggest cause, whereby arteries have become clogged with cholesterol, but major risk factors include being overweight or obese, having high blood pressure, smoking, having a poor diet high in saturated fat, alcoholism, lack of exercise, age and a family history of heart disease and heart attacks. Chronic breathlessness can also be a symptom of angina.
It’s very uncommon for under-50s to be affected by these conditions. However, cases like Fabrice Muamba, the professional footballer who collapsed on the pitch from a heart attack last year, illustrated that very fit and young people can sometimes suffer heart failure.
“For an average, fit 35-year-old with breathlessness, we wouldn’t expect it to be heart disease,” says O’Connor. “However, if there was a family history of sudden cardiac death, then cardiac causes is something that can be looked into.
“On the other hand, if a 65-year-old overweight person, with high cholesterol and a family history presents with breathlessness, then the index of suspicion changes dramatically.”
Another possible heart-related factor in breathlessness is arrhythmia – an abnormal heart rhythm – and this can affect anybody. While many forms aren’t problematic, some types of arrhythmia, like atrial fibrillation, which causes an irregular and abnormally fast heartbeat, can require treatment. If you’re concerned and have noticed that your pulse is irregular (not beating at a steady pace), see your GP. An ECG can determine whether anything abnormal is going on, and further cardio and lung-function tests can be carried out if required.
:: LUNG PROBLEMS
Persistent breathlessness, which worsens during mild exertion, can also be a sign of lung cancer and chronic obstructive pulmonary disease (COPD), which refers to conditions like chronic bronchitis and emphysema.
However, other symptoms usually present at the same time, including a persistent cough, coughing up phlegm and blood. Age is also an important factor, as is smoking.
“These diseases, although not unheard of, don’t usually occur in people under 50,” says O’Connor. “However, I sometimes see people in their late 30s or early 40s who have smoked all their lives, and are beginning to show early signs of damage.”
He notes that, often, smokers come to expect symptoms like a nagging cough, so put up with it, rather than seeking help early. But early intervention – “Number one, by stopping smoking” – can make a big difference in preventing lung damage from worsening in time.
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