Patient information · Respiratory
Breathlessness
the pattern usually identifies the cause
Being breathless when you should not be is always worth explaining. The useful information is the pattern — how quickly it came on, what brings it on, whether lying flat makes it worse — because that separates heart from lung from blood from anxiety before any test is done.
Call 999 if breathlessness is
- sudden and severe, or you cannot speak in full sentences
- with chest pain, or pain worse on breathing in
- with blue or grey lips or fingertips
- with coughing blood, or a swollen painful calf
- with confusion, drowsiness or collapse
- in a child who is grunting, or sucking in below the ribs
Sudden breathlessness with chest pain may be a pulmonary embolism, heart attack or collapsed lung, all of which need emergency assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What the pattern tells you
- Worse lying flat, better sitting up, or waking you at night gasping — points to the heart.
- With wheeze, worse at night or with exercise, cold air or allergens — points to asthma.
- Gradual over months to years, in a smoker, with a productive cough — points to COPD.
- Sudden, sharp, one-sided — points to a collapsed lung or clot.
- With pallor and fatigue, worse on stairs — points to anaemia.
- At rest but not on exertion, with tingling around the mouth and hands — points to hyperventilation and anxiety.
- Only on exertion, with chest tightness relieved by rest — may be angina presenting as breathlessness.
The common causes
- Asthma and COPD
- Heart failure, and angina or heart attack
- Anaemia — particularly iron deficiency, very common and easily missed
- Chest infection, and pulmonary embolism
- Anxiety and hyperventilation — a genuine cause, and a diagnosis of exclusion rather than assumption
- Obesity and deconditioning, which are common and improvable
- Thyroid disease, sleep apnoea, and long COVID
- less commonly: interstitial lung disease, pulmonary hypertension, and pleural effusion
Two questions worth answering before an appointment
How long has it been? Minutes to hours suggests clot, collapsed lung, asthma attack or heart event. Days to weeks suggests infection, anaemia or heart failure. Months to years suggests COPD, deconditioning or interstitial disease. And how far can you walk? A specific answer — 'I used to manage the stairs to my flat and now I stop twice' — tells us more than any adjective, and gives a benchmark to measure treatment against.
What assessment involves
- Oxygen saturation, pulse, blood pressure and respiratory rate
- Examination of heart, lungs and legs
- ECG, and echocardiography where the heart is in question
- Blood tests — full blood count, ferritin, kidney function, thyroid, and NT-proBNP for heart failure
- Spirometry for suspected asthma or COPD
- Chest X-ray, and CT where indicated
- D-dimer where a clot is being considered
Breathing pattern disorder
Some people develop an inefficient breathing pattern — upper chest rather than diaphragm, frequent sighing, breath-holding — often after an illness, anxiety or long COVID. It causes real breathlessness, dizziness and tingling despite normal lungs and heart. It is diagnosed after excluding other causes and responds well to breathing retraining with a physiotherapist, which is a specific treatment rather than a dismissal.
Why come to us. Breathlessness needs several systems assessed at once, and that usually means several appointments in several places. We do it in one: oxygen saturation, ECG, echocardiography and spirometry on site, plus full blood count, ferritin, NT-proBNP, thyroid and kidney function in-house with results explained the same visit. Chest X-ray and CT are arranged rapidly through our CQC-registered partners. Cardiology and respiratory input without a referral, seven days a week.
Heart, lungs and bloods assessed in one visit
ECG, echo, spirometry and bloods on site. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.