Breathlessness is the uncomfortable sensation of not being able to breathe. Some people refer to it as shortness of breath or difficulty breathing.
It is normal to feel breathless after significant exertion but if you feel breathless at rest, after minimal exertion or after an activity that recently would not leave you breathless then a medical condition may be responsible for this and an expert assessment is recommended.
Breathlessness has many possible causes. It can arise from problems in the lungs, heart, nervous system, or general health. Identifying the underlying cause is essential for accurate diagnosis and effective treatment.
Lung conditions are among the most common causes of breathlessness. These conditions affect airflow, gas exchange, or lung structure.
Heart conditions can reduce the heart’s ability to pump effectively, leading to fluid build-up and reduced oxygen delivery.
Neurological conditions can impair the muscles involved in breathing.
Several non-respiratory and systemic factors can also lead to breathlessness.
Breathing pattern disorder describes abnormal or inefficient breathing patterns that cause persistent breathlessness without primary structural lung or heart disease.
BPD can coexist with other conditions such as asthma or COPD, which can make diagnosis more challenging. Clinicians diagnose it through careful clinical assessment, often supported by physiotherapy or specialist breathing assessment.
A thorough and tailored approach to history taking and investigation is essential in determining the underlying cause and guiding appropriate management.
Dr Jose adopts a comprehensive and evidence-based approach to the assessment of breathlessness. Depending on the clinical context, he may utilise the following investigations:
Full Pulmonary Function Testing: Including spirometry, lung volumes, and diffusing capacity (DLCO), to assess for obstructive, restrictive, or gas exchange abnormalities.
Cardiopulmonary Exercise Testing (CPET): A detailed assessment of exercise capacity and physiological response to exertion, helping to differentiate between cardiac, respiratory, deconditioning, and dysfunctional breathing causes.
Respiratory Muscle Assessment: Including maximal inspiratory and expiratory pressures and sniff nasal inspiratory pressure (SNIP), to evaluate for respiratory muscle weakness or fatigue.
High-Resolution CT (HRCT) Scanning: Provides detailed imaging of the lung parenchyma to identify interstitial lung disease, emphysema, bronchiectasis, or other structural abnormalities.
Ventilation/Perfusion (V/Q) SPECT Scan: A sensitive tool for detecting chronic thromboembolic pulmonary disease (CTEPH) and evaluating regional ventilation and perfusion mismatch.
Other investigations: Depending on the presentation, further assessments such as echocardiography, blood tests (including NT-proBNP, D-dimer, and autoimmune screening), overnight oximetry, or sleep studies may also be considered.
This multi-modal diagnostic approach ensures a thorough evaluation of the many potential causes of breathlessness, enabling accurate diagnosis and optimal treatment planning.
Management is focused at treating the underlying condition.
In cases where breathlessness is ongoing a multi-professional approach is useful at controlling the symptom of breathlessness.
This is a programme for people with lung disease. It involves physical exercise training and education on how to manage you condition.
Supplemental oxygen may be indicated if you have low oxygen levels. This may be needed during exercise (ambulatory oxygen) or long-term.
Medication is targeted at treating the underlying condition (e..g bronchodilators in airway dsiease, diuretics for pulmonary oedema).
Anxiolytics may be helpful for patients with anxiety.
Opiates may be helpful to reduce the sensation of breathlessness.
