Breathlessness: The Practical To-Do List
Breathlessness: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
An uncomfortable awareness of breathing, from many possible causes. New or rapidly worsening breathlessness is one of the more important symptoms in medicine and is frequently attributed to being unfit.
Key takeaways
- Common causes: asthma, COPD, heart failure, anaemia, anxiety, obesity
- Sudden onset: always needs urgent assessment
- Most useful single change: Describe exactly what you can no longer do, which is more useful than a score.
- Commonest mistake: Assuming new breathlessness is simply being unfit or getting older.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Describe exactly what you can no longer do, which is more useful than a score
- Note whether it is worse lying flat or at night
- Mention any leg swelling, chest pain or palpitations
- Keep active within limits; deconditioning worsens breathlessness
Do not
- Assuming new breathlessness is simply being unfit or getting older
- Waiting to see whether it improves
- Ignoring breathlessness that wakes you at night
The numbers behind the list
The list is built from the numbers below, which come from the bodies cited at the end.
| Measure | Figure |
|---|---|
| Common causes | asthma, COPD, heart failure, anaemia, anxiety, obesity |
| Sudden onset | always needs urgent assessment |
| Orthopnoea | breathlessness lying flat, suggests heart failure |
| With one-sided calf swelling | suggests pulmonary embolism |
If you change one thing
Describe exactly what you can no longer do, which is more useful than a score. That one first, and the others when you get to them.
Where to go next
- What the Guidance Really Says About Breathlessness
- Making Sense of Breathlessness
- Breathlessness — the reference entry
- Persistent Cough: What the Evidence Actually Says
- Smoking and the Lungs: Sorting the Evidence From the Noise
When to speak to a doctor
Call 999 for sudden severe breathlessness, breathlessness with chest pain, blue lips, confusion, or inability to speak in full sentences. Seek urgent assessment for breathlessness with one-sided calf pain or swelling, coughing up blood, or breathlessness that wakes you at night. New breathlessness on mild exertion always needs a GP appointment.
Where this comes from
- NICE — Breathlessness clinical knowledge summary
- Asthma + Lung UK — breathlessness
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
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