Breathlessness can be a normal part of ageing, but having trouble breathing can also signal some serious health problems
Our lung capacity gradually falls in later life as our diaphragms and airway muscles become less powerful, our chest shape changes, nerves that control breathing become weaker, and oxygen/waste carbon dioxide transfer becomes less efficient.
Most of us cope, at least when moving on the flat, but if breathlessness is severe, starts or worsens abruptly, or is linked to cough, wheezing, chest pains, palpitations, faintness, fatigue, ankle swelling, unexpected weight loss or gain, and/or looking pale, see your GP quickly.
What can go wrong?
You may have unsuspected COPD (chronic obstructive pulmonary disease), caused by smoking and air pollution, which may not produce symptoms until it’s quite advanced. Asthma can also deteriorate or appear for the first time, and previous lung damage (for example, infections) may become more problematic.
Sudden breathlessness may indicate a blood clot (pulmonary embolism) or pneumothorax (escaped air inside the chest). And unfortunately, breathlessness may be the first sign of lung cancer, which affects non-smokers, too.
Breathlessness may also be caused by atrial fibrillation (a heart irregularity which affects 1% of people over 60 years and increases our risk of having a stroke), coronary artery disease, or heart failure (reduced heart pumping efficiency).
It may also be a sign of anaemia (‘thin’ blood makes the heart and lungs work harder), liver, kidney, thyroid or neurological disorders, or anxiety/panic attacks. And a common cause is obesity, which increases oxygen needs, while restricting our diaphragms.
Tests you may need
Your GP will ask how and when your breathlessness affects you – how far can you walk uphill and on the flat? Are you breathless when resting, or does it wake you in bed?
She’ll examine you, measure your blood oxygen levels with a finger device, and ask you to blow as fast and as hard as you can into a peak flow meter or a machine (spirometer) to assess your airways and lung capacity.
You may need blood tests for anaemia, heart failure, liver, kidney and other problems. She’ll also arrange an ECG (heart tracing) and chest X-ray, and possibly a heart scan (echocardiogram).
If you’re really unwell, she may refer you for a CT/MRI scan or even admit you to hospital for urgent tests and treatment.
This depends on the cause. You may need inhalers to open your airways and settle inflammation (asthma/COPD) or drugs such as diuretics (‘water pills’) or ACE inhibitors (names end in ‘pril’) to help your heart beat more efficiently.
If you have atrial fibrillation or a blood clot you’ll need anticoagulant drugs to ‘thin’ your blood, but if you’re anaemic you’ll need tests to find out why.
You may be offered surgery, radiotherapy and/or chemotherapy for lung cancer – international researchers say a new drug that stops lung cancer cells ‘hiding’ from the immune system could double life expectancy.
You may also be offered lung or cardiac ‘rehabilitation’ to increase your fitness and teach you ways to cope. Anxiety-related breathlessness can be helped with ‘talking treatments’ or medication.
6 ways to protect your lungs
1. Don’t smoke – and stop if you do. Get help from your practice nurse or at nhs.uk/smokefree
2. Only use household cleaners and chemicals in well-ventilated rooms.
3. Wear a good-quality dust mask or respirator if working with dust, vapours, or moulds.
4. Stay as fit as you can by maintaining a healthy weight and taking regular exercise.
5. Take asthma and other symptoms seriously; aim to be symptom free, using medication if necessary.
6. Contact the British Lung Foundation for advice and details of local BreatheEasy groups. Call 0300 003 0555, or visit blf.org.uk