Breathing problems

Most breathing problems are due to a common complaint, such as a chest infection, which can be simple to treat. However, breathlessness could also signal more serious health problems requiring medical attention, such as heart disease, a lung condition, or obesity.

Our respiratory consultants (lung doctors or pulmonologists) at Circle Health Group have access to many breathing tests that help diagnose breathing problems, including asthma, chronic obstructive pulmonary disease (COPD) and sleep apnoea.

They can then supply treatments and therapies to relieve lung-related breathing issues or refer you to a cardiologist (heart doctor) at Circle Health Group if your breathing problems could be related to the heart.

When your lungs work, you don’t have to think about it. But if you suddenly find it hard to draw breath, you’re breathless while resting or you have had symptoms for over a month, it’s essential to see your doctor.

Shortness of breath and coughs are the most common symptoms of breathing problems that our consultants see. Various conditions such as underlying lung disease, inflammatory conditions, sometimes asthma or underlying reflux disease can contribute to coughs.

Other symptoms include:

• Shallow or rapid breathing
• Chest pain
• Unexplained fatigue
• Wheeziness
• Faster heart rate
• Anxiety and panic

Certain conditions, like anaphylaxis (severe allergic reaction), can affect more than one of your body’s systems.

Doctors refer to Airway, Breathing and Circulation problems as the ‘ABC symptoms’.

How you breathe is one of many ways your consultant will work out the cause of your breathing problem.

Dyspnoea

Shortness of breath — called dyspnoea — shows that your body isn’t getting enough air. It could be a sign of asthma, poor physical health, heart failure, or even a heart attack. If breathlessness comes on suddenly, call for immediate medical aid.

There are other types of dyspnoea. If breathlessness happens when you lie down, it’s called orthopnoea. Tachypnoea means an increased rate of breathing that might occur when you lie on your side. On the other hand, lying down may make you feel better if you have rare dyspnoea known as platypnea.

Hyperventilation

Hyperventilating happens when you over-breathe and is often associated with panic attacks or a ‘fight or flight’ response to threats. You breathe in more than your body needs and expel too much carbon dioxide, causing an imbalance in the lungs.

It’s customary to be given a paper bag to breathe into when hyperventilating. You can also get more carbon dioxide into your lungs by covering your nose and mouth with cupped hands. Keep your hands there, then breathe in slowly through your nose and out through your mouth, breathing your exhaled air.

Hyperpnoea

Hyperpnoea can sometimes happen when you’re exercising heavily, making you hyperventilate. Also known as ‘forced respiration’, it occurs when you take in more air and breathe deeply to get more oxygen but don’t always breathe faster.

Medical conditions such as sepsis, anaemia and pulmonary oedema can also bring hyperpnoea on.

Everyone has a respiratory centre, like a little generator battery in the brain. Nerve impulses come down through two big nerves called phrenic nerves, which supply the diaphragm. The diaphragm is a big, domed muscle at the bottom of the lungs.

Dr Sudipta Roy, a respiratory/chest consultant at Ross Hall Hospital in Glasgow, explains how you breathe in and out normally: “During the process of inspiration (inhalation), the diaphragm contracts.

As well as the diaphragm, you have other muscles supporting the chest wall. They also contract. There’s an expansion of the chest, negative pressure is generated, and the air is drawn into the lung.

“During the expiration (exhalation) process, the diaphragm goes back to its previous upward sway to push the air out of the lungs and the other muscles.”

When your body doesn’t get enough oxygen from your heart and lungs (the circulatory system), it can lead to breathing problems. So, lung and heart conditions that cause the airways to narrow or trigger abnormalities are the most common causes of breathing difficulties.

Breathing problems can happen suddenly and last for a short time, which doctors call acute, or develop slowly and become long-lasting or chronic. An example of an acute condition is the common cold, while chronic bronchitis and sinusitis are long-term breathing problems.

If your respiratory consultant suspects heart issues, they may refer you to a cardiologist at Circle Health Group.

Respiratory/chest consultant Dr Roy said: “The common clinical conditions we see at Ross Hall Hospital in Glasgow are chronic obstructive lung disease, asthma, sleep apnoea and occasionally inflammatory conditions like interstitial lung disease (ILD).”

Many medical conditions cause shortness of breath. Here are some common lung conditions that can lead to breathing problems.

Acid reflux

Sufferers of gastroesophageal reflux disease or GERD often wonder, ‘can acid reflux cause shortness of breath?’.

The answer is yes — you can have shortness of breath, especially at night when stomach acid enters the back of the throat, oesophagus (gullet), lungs and airways. You may also have other respiratory conditions, such as asthma.

Allergies

Allergy triggers can cause wheezing and shortness of breath. Allergies range from dust mites and pet dander in the home to pollen (seasonal allergic rhinitis) and smoke and fumes in the air.

Allergies may be linked to asthma and can often make the symptoms worse. An extreme allergic reaction to fruit, nuts, bee stings or medication can also lead to anaphylaxis, which is a medical emergency.

Anaemia

Anaemia happens when your body has a shortage of red blood cells (which carry oxygen to tissue), or low haemoglobin levels (haemoglobin helps transport the oxygen).

Typical symptoms include shortness of breath, tiredness, heart palpitations and pale skin.

There are different types of anaemia with varying causes, but the most common is iron-deficiency anaemia, when the body is missing enough iron.

Anaphylaxis (severe allergic reaction)

A rare but severe allergic reaction is called an anaphylactic shock. Anaphylaxis is a life-threatening immune response to an allergy to food like fruit or nuts or an anaesthetic drug.

Among other symptoms, anaphylaxis can inflame the airways and block breathing. It can also cause people to feel faint and dizzy and lose consciousness as their blood pressure drops.

Anxiety

How can anxiety cause breathing problems? Persistent or excessive worry can provoke breathing problems such as breathlessness and fast breathing (hyperventilation). The breathlessness usually eases once the anxiety passes.

Some people feel a sense of panic when they can’t take in enough air, causing a cycle where anxiety triggers their symptoms.

Asthma

Asthma is a long-term lung disease where breathing becomes difficult because of inflamed, narrowed airways. Allergies and stress are two common triggers.

According to the British Lung Foundation, about eight million people in the UK have asthma, making it the most common lung condition.

Broken or bruised ribs

Falls, blows, and severe coughing can all cause a rib to break or bruise. The symptoms include chest pain when you breathe in.

Call 999 or go to A&E if a serious accident caused the rib to break, your breathlessness and chest pain worsens, you cough up blood, or the pain extends to your stomach or shoulder. It’s vital to seek help as something else may be damaged.

Chest infections

A chest infection affects the lungs and airways and can happen after colds or flu. It usually improves after seven or 10 days and clears up after three weeks.

Shortness of breath and wheezing are the main breathing problems, along with a chesty cough with yellow or green mucus (phlegm). Severe symptoms, such as coughing up blood, may mean you have a bacterial infection like pneumonia or a viral infection like bronchitis.

Pneumonia is life-threatening and you should seek urgent medical treatment.

Chronic obstructive pulmonary disease (COPD)

Breathing in something harmful, like cigarette smoke or noxious chemicals, can cause damage to your lungs that doesn’t go away. COPD is the umbrella description for long-term lung conditions, such as emphysema and bronchitis, where the lungs are damaged in this way.

Pulmonary means a disease affecting your lungs. Obstructive describes how airways (the tubes carrying air to and from the lungs) are inflamed and narrowed, so it’s harder to breathe.

Choking

When an object like food or a toy becomes stuck in your throat, choking can result. If the thing is so big that it blocks the throat completely, you can’t breathe.

Colds and flu

You may have problems breathing if you have a cold or flu (influenza) because the symptoms affect the airways, such as a sore throat, blocked nose, sinusitis, inflamed airways, and phlegm.

Collapsed lung

A collapsed lung (pneumothorax) can happen when you injure your chest in a car crash or an accident occurs during a medical procedure or acupuncture.

You are more prone to pneumothorax if you already have a lung condition, are a smoker or you have had a collapsed lung in the past.

Hyperthyroidism/hypothyroidism

Can thyroid problems affect your breathing? The answer is yes. Hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) are linked to your respiratory system, weakening the muscles you use to breathe.

Hypothyroidism may be associated with obstructive sleep apnoea (OSA).

Interstitial lung disease (lung scarring)

ILD is an inflammatory condition of the lung. When the inflammation settles, the lung cannot repair itself and it lays down scar tissue inside the lung. As a result of scarring, the lungs become smaller and you develop symptoms of breathlessness and sometimes a cough.

Breathing in toxic inhalants like asbestos can cause inflammation. Rheumatoid arthritis can also affect the lung and produce inflammation. If the cause is unknown, your consultant may use the term idiopathic pulmonary fibrosis.

Breathing problems after Covid

The long-term effects of coronavirus are many but include shortness of breath, chest pain or tightness and heart palpitations. If the symptoms last for more than four weeks after having Covid-19, you should get help from a medical professional.

“It’s mostly similar to having a nasty infection in the chest like pneumonia; your lung function goes down. What’s different about Covid is that some of the symptoms last a long time and they are not necessarily breathlessness,” said Dr Roy. “It’s almost like a chronic fatigue syndrome.”

Lung cancer

Breathlessness is a common breathing problem for people with cancer. According to Cancer Research UK, between 50% and 70% of cancer patients will have dyspnoea.

Primary lung cancer begins in the lungs and includes two main types: small cell lung cancer, often caused by smoking and non-small cell lung cancer (NSCLC). NSCLC includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Cancer can also spread to the lung from other parts of the body. It can cause fluid to build up in the lung (pleural effusion), making it hard to expand the chest, in the lung (pulmonary oedema) and around the tummy (ascites).

Obstructive sleep apnoea (OSA)

Obstructive sleep apnoea is a respiratory condition that causes interrupted breathing during sleep. It affects about 1.5 million adults in the UK but is often underdiagnosed.

Symptoms include snoring and blockages or partial blockages of the airways. It is most common in middle-aged males, the elderly and the overweight.

Dr Roy said: “We are coming across sleep apnoea more than a few years ago. General practitioners and others have become more aware of it. So, when you go to the GP and say you’re not having a good night’s sleep and are snoring loudly, GPs are switched on to pick up the diagnosis and send people to specialists like us for sleep studies.”

Pulmonary embolism (a lung blood clot)

Shortness of breath is common in people with a pulmonary embolism (PE), which describes a blood clot that forms a block to blood flowing in the lungs. Deep vein thrombosis in the legs or pelvis is the most likely culprit behind PEs.

Sinusitis

Can a sinus infection cause breathing problems? The short answer is yes.

Chronic sinusitis is a debilitating condition where your nose, sinuses and throat linings are inflamed for more than three months. The mucus in the sinuses builds up and the sinuses become infected and inflamed, causing difficulties when breathing through the nose.

Smoking

Smoking cigarettes can make it more likely to develop chronic bronchitis or emphysema — one of the COPD diseases. Smoking is the most significant cause of lung cancer, with symptoms that include a cough that doesn’t stop, phlegm with blood, and breathlessness or wheeziness.

Weight gain or weight loss

Can weight gain cause breathing problems? Being overweight can make it harder to breathe because excess weight puts pressure on your lungs and stress on the heart, which must work harder.

If you have a lung condition, shortness of breath can mean you eat less or are too out of breath to prepare meals. It’s essential to see a doctor who may refer you to a dietitian.

Sometimes, your breathing problems may not be a result of any of the above conditions or underlying causes.

Here are some rare lung conditions that cause breathing trouble:

• Asbestosis – a lung disease caused by inhaling asbestos fibres
• Birt-Hogg-Dubé syndrome (BHD) – a complex genetic skin disorder that can cause cysts in the lungs and lung collapse
• Guillain-Barre syndrome (GBS) – a progressive inflammatory disease that weakens the breathing muscles
• Mesothelioma – rare cancer that affects the pleura (membrane) lining the lungs and chest cavity
• Sarcoidosis – an inflammatory condition affecting the lungs and other organs
• Tuberculosis (TB) (also called consumption) – an acute/chronic bacterial lung infection

Your consultant will help you get to the bottom of your breathing problems and rule out any of the above rare lung conditions.

What heart problems cause shortness of breath?

The British Heart Foundation says breathlessness could also be a sign of coronary heart disease, with the following conditions causing breathlessness.

Angina

People with angina can experience breathlessness and chest pain caused when not enough blood goes into the heart muscles.

Atrial fibrillation/abnormal heart rhythms

Shortness of breath is one of the symptoms of atrial fibrillation, where the heart beats irregularly and sometimes fast.

Heart attack

The common symptoms of a heart attack are chest pain, pain spreading to one of your arms, neck, jaw, back or stomach, and feeling sick. But it can also cause a build-up of fluid in your lungs, leading to coughing or wheezing.

Do not delay calling for an ambulance if you think you have a heart attack.

Heart failure

Heart failure happens when the heart muscle becomes weak, and blood fails to pump around the body at the correct pressure. Weakness, tiredness and breathlessness are common symptoms even when resting.

Respiratory infections in children are common. It’s normal for coughs and colds to happen six or eight times a year and for babies’ and toddlers’ breathing to sound noisy or chesty.

However, if you instinctively feel something isn’t right, you should get them checked out by a doctor.

You must get urgent treatment for your child if they are:

• Breathing faster
• Wheezing on the out-breath
• Making a high-pitched sound or grunting sound when breathing
• Regularly pausing or stopping breathing
• Showing their ribs at each intake of breath
• Having a fit
• Turning blue or pale

Asthma

Breathlessness, chest tightness, wheezing and coughing could all be signs of asthma, starting in childhood or adolescence. Some children grow out of it through adulthood. All kinds of tests are used to investigate and diagnose asthma.

Bronchiolitis

Babies and children under the age of two can get this common chest infection, which includes symptoms such as breathing faster and wheezing, among others. It’s usually mild and will go away of its own accord after five days. It should be investigated if it continues.

The usual pathway to a respiratory consultant is through your GP for breathing problems such as coughing and breathlessness. Your doctor may send you to a consultant if:

• The GP is struggling to manage your symptoms
• They want a diagnosis from a specialist
• Your breathing problems are new
• Breathlessness or a condition like asthma has worsened
• You feel out of breath after exercise but didn’t before
• Your feet and ankles are swollen
• Breathing problems coincide with a fever, chills and wheezing
• Your shortness of breath gets worse lying down

You can also self-refer and book to see a respiratory consultant at Circle Health Group. Find out how to pay for private treatment at Circle Health Group.

If breathlessness is accompanied by chest tightness, pain spreading to your arms, back, neck and jaw, blue-tinged lips, faintness, and nausea, it is a particular cause for concern. You should dial 999 as these are symptoms of a heart attack or pulmonary embolism.

Other symptoms that need immediate medical attention are continued breathlessness even when sitting or resting and when it gets so bad that it seriously affects your quality of life.

Consultants at Circle Health Group can choose from various diagnostic tests to find out what is causing breathing problems. Tests range from blood tests and well-known imaging techniques to lung function tests.

X-ray

You may be sent for an X-ray of your lungs straight away at one of our hospital’s imaging departments, with the results often available at the same appointment.

Computerised tomography (CT) scan

A CT scan provides the respiratory consultant with a more detailed picture of your chest than an X-ray to aid their diagnosis.

Blood tests

If you have suspected asthma or sinusitis, your consultant may arrange for a blood test to discover whether you have any allergies.

Hospitals cannot run a proper respiratory unit without lung function tests. Respiratory consultants have access to the complete range at Circle Health Group, helping them figure out the cause of your breathing problem.

Pulmonary function tests or lung function tests, such as spirometry, measure your lungs’ performance and how much oxygen they hold. They help our consultants to diagnose many diseases associated with breathing problems, such as asthma, respiratory infections, asbestosis, lung scarring and COPD.

Spirometry

In a spirometry test, you take a deep breath into a mouthpiece and a rapid breath out. The mouthpiece is connected to a computer that monitors your air for speed and volume. It helps the consultant discover whether you have an underlying lung condition.

Fractional exhaled nitric oxide (FeNO) test

The exhaled nitric oxide or FeNO test measures the nitric oxide in your breath to check for asthma. If nitric oxide levels are elevated, it might tell a consultant that you have asthma or that any asthma present is not well controlled.

Lung plethysmography or volume test

You may hear your doctor call a lung volume test body ‘lung plethysmography’. It tests how much air you can keep in your lungs and the amount left when you breathe out as much as you can.

Gas diffusion test or lung diffusion capacity test       

In a gas diffusion test, your lungs are measured to see how oxygen moves from them to your bloodstream. This complicated lung function test checks the efficiency of the lung’s uptake of oxygen, which is extracted from the air into your blood.

It should be over 90% in normal healthy lungs, but it could be below if you have established lung disease. In ILD, for example, the lung tissue may be destroyed or there isn’t enough blood supply, so you cannot efficiently shift oxygen from within your lung to blood.

Serial peak flow

In a serial peak flow test, you blow forcefully into a plastic tube with numbered marks from 50 to 400 upwards. Depending on the strength of your blow, an indicator gives a number showing whether the airways are open enough. You should get a figure expected for your height, age, and sex if they are.

Respiratory/chest consultant Dr Roy explained: “If you are a 5ft 2” female and 45 years of age, your expected peak flow is around 300-350. If you are a 5ft 11” man and 45 years of age, the predicted peak flow is 550-600.

“A serial peak flow test is a useful tool we use mostly to monitor asthma because your airways change to respond to different stimuli and irritants. They narrow, then open. When they narrow, your peak flow drops. When they open, it goes up again.”

Pulse oximetry

Oximetry is the measurement of oxygen content in the blood.

You wear a probe on your finger. 95-96% oxygen saturation is normal. If you have lung disease, the percentage will be lower. People with COPD measure a level around the mid-80s or less. Inflammatory conditions can have low oxygen levels, too.

In hospitals, pulse oximetry is a helpful tool to monitor oxygen levels, which can be adjusted accordingly.

The British Medical Journal (BMJ) says many patients hospitalised with acute Covid-19 have severe hypoxia (low blood oxygen). UK guidelines recommend pulse oximetry to assess and monitor symptoms of people with suspected Covid.

Bronchodilator reversibility

If you might have underlying asthma, the consultant will suggest a spirometry blow test to check the calibre of your airways. If the calibre is narrow, they will give you a bronchodilator in the form of medication through a nebuliser called salbutamol.

After giving you a dose, the consultant will recheck your spirometry to see whether the narrowness has or hasn’t improved. If it improves, there is reversibility because we can see the change in the figures. There are certain figures for this to calculate.

Bronchial challenge tests

If you have had spirometry and FeNO tests, but your consultant is still unsure whether you have asthma, they may suggest taking a bronchial challenge test.

Here, one inhales inert substances like Mannitol and serial spirometry is carried out to see any progressive lowering of the figures. This may indicate that airways are sensitive, often the case in asthma.

Cardiopulmonary exercise test (CPET/VO2 max)

Cardiopulmonary exercise testing can help your consultant to measure your fitness. The tests are also known as a CPET VO2 max test because they measure your maximum oxygen consumption rate during exercise.

A CPET/VO2 max test is not used routinely. It’s only used if someone is breathless and it can’t be explained. A respiratory consultant may want to check your heart and lungs simultaneously to see which organ is at fault or if you are going to surgery and a surgeon wants to check whether you are fit enough.

You cycle or walk on a treadmill while they measure your oxygen consumption and heart rate. The measurements help them understand which organ is not working correctly or may show that someone is frail.

Sometimes, diagnostic procedures may need to be carried out to look into the lung. 

Bronchoscopy

A bronchoscopy involves the consultant passing a slim, flexible tube through your nose and into your lung areas. The tube has a light on it, so they can see where to take a sample (biopsy) for later analysis. It is used to see whether there is anything abnormal in your lungs.

Lung biopsy

During a bronchoscopy, you may have a lung biopsy. The lung specialist removes pieces of lung tissue using a needle to find out the exact nature of the breathing problem from the sample.

Treatment for breathlessness depends on the cause, which your consultant will determine through tests and your assessment. Afterwards, they will agree on an action plan with you.

Asthma treatments

The main types of treatment for breathing problems like asthma are preventer inhalers such as beclomethasone and fluticasone, and reliever medicines such as salbutamol.

You may also be prescribed a long-acting bronchodilator to widen the lung airways. As the name suggests, they last longer than reliever inhalers.

COPD treatments

Our respiratory consultants can provide long-term monitoring and treatment if you have COPD, ranging from cardiovascular exercise to inhalers and medications.

Oxygen therapy may also be prescribed and monitored carefully.

Pneumonia and lung infections

If an X-ray confirms you have pneumonia or other lung infections, treatment depends on whether it’s bacterial or viral. If it’s bacterial, you’ll be prescribed oral antibiotics, but these will not work if the cause is a virus.

Lung cancer treatments

Cancer treatment depends on the type of lung cancer you have and whether it has spread. The treatments commonly include chemotherapy, radiotherapy and surgery (primarily for NSCLC). Find out more about lung cancer treatment.

Long Covid treatments

For long Covid patients, your consultant might refer you to our physiotherapy, occupational therapy, or other rehabilitation specialists.

At Circle Health Group, our long Covid rehabilitation services include the use of bespoke equipment to increase your breathing capacity and mobility.

Weight loss treatments

Your consultant may recommend lifestyle changes. For example, if you are a smoker, they will urge you to stop smoking. You’ll be encouraged to lose weight if you are overweight because being overweight can make it harder to breathe.

You’re in the right place to find what’s causing your breathing problem and access treatments and therapies that relieve your symptoms.

We have many highly trained and experienced respiratory specialists in breathing problems at hospitals throughout Circle Health Group in England, Wales and Scotland, from London to Carmarthen and Manchester to Glasgow.

With access to many breathing tests, from lung function tests to biopsies, our breathing experts have all the tools they need to diagnose various conditions, including asthma, COPD and sleep apnoea.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Support by the same compassionate clinical team from beginning to end
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about this procedure, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Dr Sudipta Roy in May 2022. Next review due May 2025.