BREATHLESSNESS

• ASTHMA. This is probably the commonest cause. Asthmatics should have detailed information from their doctor or the asthma clinic giving guidance about when to call for medical help - if not then please discuss this at your next review appointment. In the absence of more personalised guidance then asthmatics should seek help if any of the following occur:

  • Breathlessness prevents the patient talking in sentences.

  • The patient is finding breathing requires a lot of effort.

  • The patients condition is getting worse - especially if inhalers are losing their effect quickly or not working at all.

  • The patients colour shows a bluish tinge.

  • Peak flow after usual treatment is down 20% on best figures.

  • The patient has a productive cough - especially if associated with increased breathlessness and/or a fever.

  • The patient seems confused or "not themselves".

• HEART FAILURE. If the heart is not working as well as it should then fluid can build up in the tissues. If this is in the legs then "oedema" or swelling occurs - this usually "pits" when pressed with the finger. If the fluid builds up in the lungs then breathing is affected. If this occurs gradually then the breathlessness may also come on gradually and may not be noticed initially. Much more sudden accumulation of fluid also occurs and can cause a life-threatening breathing crisis - sometimes a heart attack can cause this to happen. The patient is obviously very unwell when this happens with bubbly or wheezy breathing and often feels cold and clammy and looks pale or grey. This is a real emergency and the treatment is a "water tablet" drug given by injection for rapid action and oxygen to breathe so urgent medical attention is required. Call us for advice on what to do - the doctor may come him/herself immediately or may suggest a 999 ambulance or both depending on circumstances. Whilst waiting the patient should be SAT UP to reduce the accumulation of further fluid - if able to speak they will usually indicate that this is what they need to do.

• PNEUMOTHORAX or punctured or collapsed lung. Although much rarer than heart failure and asthma this occurs relatively often without warning in a fit young person but certain people such as asthmatics and people with a previous history of pneumothorax a more prone to getting it. The lung is lined by a membrane called the pleura. The same membrane lines the inside of the chest wall. Normally the two thicknesses of membrane touch each other and because they are lubricated glide freely over one another. If the membrane lining the lung tears (or is pierced by a weapon or in an accident) then air gets into the space and the lung collapses. If a lot of air gets in then the amount of lung collapse can be sufficient to embarrass breathing and the heart may be pushed over if the air is under pressure. The patient will be very breathless and may be blue with a pain on the side of the pneumothorax - they may be in a state of collapse. This is an emergency and the patient needs to be in hospital so that a drain can be inserted into the chest to remove the air. Sometimes the amount of air may be much less and the patient just has some sharp pain in the chest so that it takes a chest x-ray to show the presence of the air between the membranes. Small pneomothoraces like this usually clear up by themselves but this will need to be checked by further x-ray(s)

• PULMONARY EMBOLUS or clot on the lung. As with pneumothorax this might be big or small and so the symptoms may also vary from severe breathlessness, a deep blue skin colour and collapse to a sharp pain in the side of the chest and perhaps the coughing up of some blood. The blood clot comes from elsewhere in the body - usually the deep veins in the leg, thigh or pelvis or the heart lining itself. Occasionally this can occur for no obvious reason in a healthy person - there is a slight increase in risk with the contraceptive Pill - but usually there is a cause such as a period of illness in bed, a surgical operation or a heart irregularity. Depending on severity of the symptoms either the ambulance or GP should be called.  After immediate measures such as oxygen the treatment usually involves the use of blood thining drugs - heparin by injection to start with followed by warfarin tablets. People at special risk may be given preventative heparin or warfarin - often an injection of heparin is given before certain orthopaedic operations.

• PANIC ATTACKS often cause breathlessness. The patient or companion may recognise the symptoms from a previous attack. A first attack is difficult for the lay person to certain about so it is wise to seek advice even if you feel sure that an attack is a panic attack though the doctor may be able to advise by telephone. Typical symptoms include a feeling of severe anxiety that something is going to happen, a feeling that not enough air is getting into the lungs and tingling of toes, fingers and around the mouth. In severe prolonged attacks there may even be muscle spasms due to the rapid breathing upsetting chemicals in the blood. The main problem is the rapid shallow breathing caused by severe anxiety feelings and this causes frightening sensations which in turn aggravate the problem. Reassurance is valuable whatever the cause of the breathlessness. If a panic attack is certain then get the patient to breathe in and out of a paper bag (this raises the CO2 level which is reduced by the rapid breathing and which causes many of the unpleasant symptoms). Also slow deep abdominal breaths should be encouraged instead of the rapid shallow chest breathing that the patient feels the need to make - encourage gently and supportively. If the patient fails to respond or if there is doubt about the diagnosis then ring for advice.

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