Feeling out of breath? 5 red flags you should never ignore, according to a lung doctor

Many of us have experienced that temporary feeling of being winded, but when is dyspnoea – the medical term for shortness of breath – a sign of more serious health issues? 

As Dr Luis Arvelo, Head of Pulmonology at Madrid’s Virgen del Mar University Hospital, explains, dyspnoea isn’t a disease in its own right, but rather a common symptom of various respiratory, cardiac and systemic conditions. It’s important to note that it can happen during moments of physical exertion, but also while you’re at rest.

The major causes: Is it your heart, lungs or something else? 

Dr Arvelo outlines several respiratory conditions that can lead to dyspnoea, including asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary fibrosis and pulmonary embolism. “These conditions hinder the flow of air in and out of the lungs, making it difficult for the body to get enough oxygen,” he explains.

The medical expert further notes that heart conditions, such as heart failure and myocardial infarction (a heart attack), can also cause breathlessness by disrupting blood circulation and leading to fluid build-up in the lungs. “Other causes include anaemia, which reduces the amount of oxygen the blood can carry, and anxiety disorders, which can lead to hyperventilation or a choking sensation,” he says.

Red flag symptoms: The warning signs that require urgent attention 

How does it manifest, and what are the warning signs that something is really wrong? Dr Arvelo’s red flags include:

• Rapid or shallow breathing
• A tight sensation in the chest
• Needing to pause for breath while speaking or carrying out daily tasks

He adds, “You might notice the muscles in the neck or abdomen working overtime, which indicates the body is struggling to pull in enough oxygen. Or you might feel the need to sit upright or lean forward just to catch your breath.” 

If breathlessness is accompanied by:

• A bluish tint to the lips or nails
• Profuse sweating 
• Confusion

“You need to seek emergency medical help immediately,” he warns.

The diagnostic journey: What to expect

If symptoms persist, don’t hesitate to see your doctor to confirm a diagnosis. “The process begins with a thorough medical assessment, including a full clinical history and physical examination,” explains Dr Arvelo. 

“The doctor will ask about the duration and frequency of the breathlessness, any specific triggers and whether it is accompanied by other symptoms like a cough, chest pain or leg swelling.”

The lung specialist outlines several common tests used to pinpoint the source of the problem:

• Spirometry: This measures lung function and is essential for diagnosing conditions such as asthma or COPD.
• Chest X-rays and CT scans: These imaging techniques allow doctors to visualise any abnormalities within the lungs or heart.
• Blood tests: These help to detect anaemia or underlying infections, while an arterial blood gas (ABG) test evaluates the levels of oxygen and carbon dioxide in the bloodstream.
• Cardiac investigations: If a heart issue is suspected, an electrocardiogram (ECG) or an echocardiogram may be required to assess heart rhythm and function.

Acute vs chronic: Why the timing of your breathlessness matters

The specialist clarifies that acute dyspnoea comes on suddenly and is typically linked to conditions such as asthma attacks, pneumonia, a pulmonary embolism or heart failure. 

In contrast, chronic dyspnoea develops gradually over time and is more common in long-term diseases like chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis.

“We also categorise breathlessness based on posture or activity,” explains Dr Arvelo. “Exertional dyspnoea occurs during physical activity, whereas rest dyspnoea appears without any exertion at all and usually indicates a more serious underlying issue. 

Then there is orthopnoea, which happens when lying flat and improves upon sitting up: a common sign of heart failure. Finally, there is paroxysmal nocturnal dyspnoea, which causes a person to wake up gasping for air in the middle of the night.”

Beyond the physical: How dyspnoea impacts mental health and lifestyle

A condition like dyspnoea can truly impact a person’s quality of life. Dr Arvelo emphasises that those suffering from breathlessness often experience constant fatigue, finding it difficult to walk or climb the stairs, and may even struggle to speak without running out of air.

“This can lead to a loss of independence, as people often have to modify their daily routines to avoid any physical exertion,” he explains. “Furthermore, the constant struggle to breathe can trigger anxiety, stress and fear, which in some cases leads to social isolation or depression.” 

In more severe instances, dyspnoea can significantly disrupt sleep and rest, resulting in insomnia and total exhaustion.

Modern treatments: Managing symptoms with medication and rehabilitation

What are the treatments available to relieve the symptoms? “Firstly, medication plays a key role. Bronchodilators and corticosteroids help to reduce obstruction and inflammation in the airways for those with asthma or COPD,” explains the specialist.

“In cases of heart failure, diuretics (often called ‘water tablets’) can relieve breathlessness by reducing fluid build-up in the lungs. Additionally, sedatives or anxiolytics may be used to manage the anxiety that often comes with difficulty breathing.” 

He adds that another common treatment is oxygen therapy, which is used when blood oxygen levels are low, providing much-needed relief for those with chronic lung disease or certain heart conditions.

“Pulmonary rehabilitation is also incredibly useful. It helps improve lung capacity through tailored physical exercise and specific breathing techniques, which in turn reduces breathlessness and improves overall quality of life,” says the expert.

The prevention guide: Lifestyle changes to protect your lung health

Finally, we wanted to look at whether there are preventive steps you can take to lower the risk of developing dyspnoea. 

Prevention is possible – and the doctor places particular emphasis on the role of smoking. “In many cases, breathlessness can be prevented, or at least minimised, through a few key lifestyle changes,” he states.

“The most vital step is to avoid tobacco; smoking is a primary cause of lung diseases like COPD and asthma, both of which are major triggers for dyspnoea. Also try to limit your exposure to air pollution, as poor air quality can significantly worsen respiratory conditions.”

He also highlights the importance of maintaining a healthy weight and staying active. Regular exercise boosts your lung capacity and reduces the strain on your cardiovascular system, helping to ward off respiratory issues before they start.

“Finally, it is essential to keep chronic conditions like asthma, COPD or heart failure under control by following your prescribed treatment plan and attending regular check-ups,” says the doctor.