Breathlessness: when to be concerned, causes and treatments

Breathlessness, which is medically known as dyspnoea, is the unsettling sensation of not being able to breathe in enough air. It is a subjective feeling that many individuals describe as a feeling of suffocation or ‘air hunger’.

Understanding what is normal when it comes to breathing can help you recognise when breathlessness may be a sign of something more serious. 

What is normal breathing?

Breathing is the body’s natural process of bringing in oxygen and expelling carbon dioxide. 

A healthy adult typically takes about 12–20 breaths per minute at rest. Their breathing is typically quiet, effortless and does not need any thought. 

It is completely normal to feel breathless during physical activity, such as climbing the stairs or exercising, but this usually improves quickly with rest. 

Types of breathlessness

Breathlessness can become a cause for concern when it happens unexpectedly or during activities that previously caused you no difficulty. It can range from mild, where it only occurs on exertion, to severe, where it occurs even when resting. 

Breathlessness is often classified as either acute or chronic (long-term). Acute breathlessness develops suddenly and can suggest an urgent medical issue, such as an asthma attack, blood clot, severe infection, pneumonia or heart problem.

Chronic breathlessness develops gradually over weeks, months or years, and may be linked to long-term health conditions, such as asthma, chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). 

Causes of breathlessness 

Breathlessness can stem from a wide range of conditions affecting different parts of the body. In some cases, it can be due to a single issue, while in others, it can be due to a combination of factors. This can include: 

• Lung-related conditions eg asthma, COPD, ILD, lung cancer, cystic fibrosis and infections such as pneumonia or tuberculosis
• Heart-related conditions eg abnormal heart rhythms, coronary heart disease, heart failure and heart valve disease
• Musculoskeletal conditions eg chest wall deformities such as scoliosis or pectus excavatum
• Neuromuscular conditions eg spinal cord injury, brainstem disorders, muscular dystrophy and motor neuron disease
• Prolonged immobility that leads to weakening (deconditioning) of the respiratory muscles
• Other causes such as anxiety, anaemia or post-COVID syndrome

Risk factors for breathlessness

The most significant preventable risk factor for developing breathlessness is smoking, which causes long-term damage to the lungs and blood vessels. Smoking significantly increases the risk of conditions such as COPD, lung cancer and heart disease. 

Other common risk factors include having chronic heart or lung conditions, such as asthma, ILD or heart failure. A family history of respiratory or cardiovascular disease can also raise your risk.

Occupational exposure to airborne substances such as dust, fumes, chemicals or gases is another key risk factor. People working in environments like construction, farming, mining or manufacturing may inhale harmful particles over time. This increases the likelihood of developing chronic lung diseases. 

Additionally, post-viral syndromes, particularly long-COVID, have emerged as a growing cause of persistent breathlessness that continues after the initial viral infection has resolved.

Other factors such as excess weight, physical inactivity and poor general fitness can also lead to or worsen breathlessness, especially during exertion. In these cases, the body must work harder to meet oxygen demands, making even mild activity feel more difficult. Identifying and addressing modifiable risk factors — that is, risk factors you can change — can play a key role in preventing or improving symptoms of breathlessness over time.

Symptoms of breathlessness

Breathlessness can feel like a tight chest, difficulty getting enough air or a sense of “air hunger”. It may come on suddenly or develop gradually and is often accompanied by other symptoms, depending on the cause. These can include: 

• A persistent cough
• Chest tightness
• Fatigue
• Rapid or shallow breathing
• Wheezing 

How is breathlessness measured? 

Breathlessness can be categorised by severity in different ways depending on the underlying cause. 

However, the modified MRC (Medical Research Council) dyspnoea scale is a common tool used widely to grade breathing. 

The MRC scale has five grades from grade 0 to grade 4: 

• Grade 0 — only becoming breathless when exercising strenuously 
• Grade 1 — becoming breathless when exerting yourself (eg brisk walking) on level ground or when walking on a slight incline
• Grade 2 — becoming breathless when walking on level ground or needing to walk slower than people your age on level ground 
• Grade 3 — needing to stop walking on level ground after a few minutes or after about 100 yards (91 metres) due to breathlessness 
• Grade 4 — being too breathless to leave the house and/or being unable to get dressed or undressed without becoming breathless

This scale helps monitor how symptoms progress over time. 

When to seek help for breathlessness 

Breathlessness can have many causes; some are mild while others are more serious. So it is important to know when to seek medical advice. Not all breathlessness requires emergency care, but it should never be ignored, especially if it is new or changing. 

You should see your GP if you:

• Experience breathlessness that is new, persistent or getting worse
• Find it difficult to complete everyday activities without becoming breathless
• Have accompanying symptoms such as a persistent cough, fever, night sweats or unexplained weight loss

Call 999 or go to A&E immediately if you experience:

• Sudden or severe breathlessness at rest
• Chest pain
• Blue lips or fingertips
• Confusion or fainting
• Low oxygen levels (which can be monitored using a home pulse oximeter)

Diagnosing breathlessness

Diagnosing the cause of breathlessness starts with a detailed consultation and physical examination. 

Your doctor will ask: 

• When your symptoms started
• Whether your symptoms came on suddenly or gradually
• What triggers your symptoms
• Whether your symptoms occur at rest or only during exertion
• Whether you have any other symptoms eg a cough, chest pain, wheeze, fatigue, weight loss or leg swelling 

Your doctor will also take a thorough medical history.  This will include asking you for information about any existing lung or heart conditions, autoimmune diseases, recent travel, occupational exposures and smoking.

Following your initial assessment, your doctor may recommend a range of tests tailored according to your symptoms and medical history. This may include blood tests, a chest X-ray, a chest CT scan, lung function testing, oxygen level monitoring and an ECG or echocardiogram if a heart condition is suspected.

Treatments for breathlessness

Medical treatments

Treatment for breathlessness depends entirely on the underlying cause. Identifying and addressing the root issue is the first step towards managing symptoms effectively.

Asthma and COPD treatment

These are managed with inhalers to open the airways and reduce inflammation. 

Corticosteroids (inhaled or oral) may be used to reduce airway inflammation, especially during flare-ups. 

You may also be referred for pulmonary rehabilitation, which is a structured programme of education and exercise that has been proven to improve symptoms and enhance quality of life.

Interstitial lung disease (ILD) treatment

Treatment depends on the type and severity of your ILD. 

Options may include immunosuppressants for inflammatory ILD and antifibrotic medications, such as nintedanib or pirfenidone, for conditions such as idiopathic pulmonary fibrosis. 

Early diagnosis and specialist care are important for long-term management. 

Heart failure treatment

Treatment may involve diuretics to reduce fluid buildup and medications such as ACE inhibitors and beta blockers to support heart function. 

In some cases, cardiac devices may be used to help regulate the heart rhythm. 

Lifestyle changes

Alongside medical treatment, lifestyle changes can make a big difference. Stopping smoking is one of the most important steps anyone can take. 

Regular physical activity, even in small amounts, can improve breathing efficiency, build stamina and help reduce the sense of breathlessness over time.

Maintaining a healthy weight is also important as excess weight can compress your lungs and increase the effort needed to breathe. 

A balanced, nutritious diet supports energy levels, reduces fatigue and can help manage health issues related to your breathlessness, such as diabetes or anaemia. 

Preventing respiratory infections is another key part of managing breathlessness. Staying up to date with vaccinations, including annual flu jabs, pneumonia vaccines and COVID-19 boosters, is especially important for people with chronic respiratory or heart conditions. 

Breathing techniques, such as pursed-lip and diaphragmatic breathing, can help you manage your breathlessness during activity. These are often taught as part of respiratory physiotherapy or pulmonary rehabilitation. 

Managing stress and anxiety is also essential as these can worsen your symptoms. Relaxation techniques, mindfulness and, where appropriate, talking therapies can help improve your breathing control and confidence too.

Oxygen and breathlessness

Oxygen is not routinely recommended for breathlessness unless your oxygen levels are low. While it may seem intuitive to think that more oxygen will help you breathe better, this is not always the case. 

Breathlessness does not always occur alongside low oxygen levels and in many chronic conditions, such as COPD or ILD, people can feel severely breathless even when their oxygen levels are within the normal range.

In fact, using oxygen unnecessarily can be harmful. In certain individuals, particularly those with chronic respiratory conditions, excess oxygen can lead to a dangerous buildup of carbon dioxide in the blood (hypercapnia). This can cause drowsiness, headaches, confusion or even worsen breathlessness.

Oxygen therapy should only be started after a thorough assessment, which may include oxygen level measurements at rest and during activity — this is often part of a walking oxygen measurement test.  

If needed, oxygen can be delivered in controlled amounts at home under close medical supervision. A healthcare professional will assess whether oxygen therapy is needed and ensure it is used safely and appropriately. 

What is on the horizon?

Research into biomarkers and personalised treatment is rapidly evolving. Studies are helping predict which patients respond best to specific treatments, from antifibrotic drugs in ILD to advanced imaging techniques for early disease detection. 

Final thoughts

Breathlessness is a common and often distressing symptom. While it can be caused by something minor and reversible, it is often linked to long-term health conditions. 

For many people, breathlessness becomes a part of daily life, but with the right diagnosis, treatment and support, your symptoms can often be improved. In some cases, especially when the underlying cause is treated effectively, breathlessness can resolve completely. 

Even when a complete cure isn’t possible, tailored management can significantly reduce your symptoms, improve your lung function, enhance your quality of life and help you feel more in control of your symptoms.