Knowing your breathing is abnormal is not entirely straightforward.
So, let me explain.
We're not normally conscious of our breathing.
We just breathe and we don't think about it.
But one can become aware of your breathing fairly easily and we do this in everyday life.
So, for example, now that we're talking about breathing, you're probably aware of your breathing,
or if you run for a bus, this is not a normal level of exercise for you, so you usually
become quite conscious of your breathing; if you do something like that.
One can become very abnormally aware of his breathing, either because you're in an abnormal
situation or because there's something wrong with the heart or lungs.
So, if we think of abnormal situations, if you're running for your life, you actually
use up or exceed the ability of your heart and lungs even though they're perfectly normal
to get oxygen to your muscles, so you can come very distressed and quite frightened
because you feel that you're dying from lack of breath in situations like that.
We also have a very powerful instinct that if we are very afraid, if we're very fearful,
we become very aware of our breathing.
So, if you have something to do is try to hide from bad people or bad animals or something
of the kind, we can just become very aware of our breathing because we're frightened.
This can cause confusion because obviously if anxiety can cause breathing problems or
become aware of your breathing, you can equally, in people who are breathless, become very
anxious and knowing which is a chicken and which is the egg, in that situation
can take some unpicking.
So, in general terms, if you want to talk about abnormal breathing and abnormal body
conditions that cause breathing problems, we're looking at sudden or rapid onset acute
breathlessness, so this is where over a period of minutes or days one becomes very distressed
by one's breathing.
And this can be very obvious.
You can feel that there's a tightness in your chest that you can't expand, you can feel
that you're suffocating or you can come panicked by breathing.
And all of those could be signs that there's something really significant going on.
But you can just simply become aware of your breathing being heavy because you got a bad cold.
The more subtle one is what we call chronic breathlessness.
So, this is something that's happened over weeks or months and you've lost the ability
to exercise normally.
So, something that you've been able to do last year, you can no longer do
because the breathing stops you.
And it's being aware that the breathing stops you is the difficult bit.
We have a natural tendency to try and reduce our level of effort
so that we don't become breathless.
And therefore, one can just simply feel that one's getting unfit.
And it's sometimes only after you query and dig into the reason why somebody is not exercising
that you find they're doing that to avoid become breathless.
We need to think of things like thyroid disease.
Because if the thyroid is severely overactive, the muscles can demand more oxygen than your
heart and lungs could provide.
And then we need to think of things like kidney disease, because kidney problems can cause
an inability to get rid of fluids from the body, that builds up pressure in the lungs
and causes high blood pressure, which can put more pressure on the heart, so a normal
lung and heart can be asked to do too much.
So those things need to be kept in mind, but actually, what we're generally thinking about
is the lungs and the heart.
Now, when it comes to trying to unpick what is going on with the lungs and the heart,
we tend to try and divide breathlessness into how rapidly it's come on.
So, we have what we call acute breathlessness.
It's rapid onset, either appeared today or appeared in the last few days.
And we have chronic breathlessness, that which is occurred slowly over a period of time.
And generally talking, there are about weeks or months.
So, if we start with the acute, we need to think about the lungs and what's going on
with the lungs, and then infection of the lungs would be a very common reason for someone
to become breathless over a short period of time.
So, a common cold, through to the flu or bronchitis or pneumonia,
all of these can cause significant breathlessness.
We also need to think about asthma.
Because asthma often causes sudden severe constriction of the airways which makes you
acutely breathless which normally you can manage quite well.
In the heart, we need to think about acute heart failure.
So, a heart that was working pretty well yesterday, and it what you wanted it to do, and now suddenly
isn't able to do that.
And the kinds of things that can cause that would be a heart attack.
So, if you suddenly block off the blood supply to your heart and the heart becomes so weak
that you can no longer keep your lungs free of fluid,
that would make you very breathless indeed.
Or a severe rhythm problem.
If you have a very rapid heart rate, the heart can't function satisfactorily and can make
you very breathless.
And finally, sometimes an infection in heart can cause a valve to suddenly rupture and
then the heart becomes inefficient.
So acute-severe problems, need to thought about, sometimes acute-mild problems.
We also need to think about the lung tissues.
So smoking damage and other damage can cause emphysema; which means that you can't-- although
you can get the air into the lungs, you can't get it efficiently through the blood.
Or scarring conditions of the lungs which are called pulmonary fibrosis.
The final group to actually think about is acute and chronic.
And this is where you've got a weakened lung or a weakened heart.
That means that you're normally somewhat breathless, but you've lost a lot of reserve.
So in that situation a very minor change can suddenly result in severe breathlessness.
And finally, somebody with a weakened heart that have a minor rhythm problem that other
people would just get some palpitations from, can become severely breathless.
Clearly a worry if one develops sudden severe breathlessness.
And if that's associated with other things like, you know, fear, feeling panicked, feeling
like you're suffocating, the feeling of inability to expand your chest, that's obviously a worry.
And we're going to look for things like, are you having an acute asthma attack, have you
developed acute heart failure, is there an abnormal rhythm that's going on here, have
you collapsed a lung, have you a bit of a clot in your lung?
So, a sudden severe breathlessness obviously would be something that one has to take a
big interest in.
On the other hand, one can also have more gradual onset to breathlessness.
That also needs to be investigated and should be worried about.
And in essence here, the story is, what do you normally do and are you able to do much
that you could do last month or last year?
But if you're doing the same sort of exercise that you did last year: walking the dog, going
uphill and now you can't do that, that's a clear change.
And I'd say one has to be very careful.
We don't often notice that it's due to breathlessness.
You feel that you're getting unfit, you feel that you're getting old, you feel that you've
put on weight, all sorts of excuses are generated to say, "I think this might not be real".
In terms of the lungs, one might notice a cough or producing phlegm.
So, it's mucus from the chest.
Or you might notice coughing up blood.
So, signs like that will tell you that there's something much more going on than just breathlessness.
Persistent new cough can often indicate some scarring in the chest which is very important.
Blood is always very serious and should be investigated.
Chest discomfort particularly when you're breathing in is often a sign that breathing
is serious and of course even with short-term breathlessness, if you've got a temperature
or sweating at night, that could indicate there's an infection underlying this.
So, breathlessness at rest is usually a bad sign and we tend to take that very seriously.
Certainly, if you find yourself fighting for breath and very worried, call 999.
There's nothing else to do other than get it sorted out.
There are situations where you might be used to being very breathless and having episodes
of breathlessness at rest.
So, for example, somebody who's got severe asthma, somebody who's got severe lung or
heart disease, we may be at the limits of our treatments.
This may be well known to you and you may have been advised what to do in order to relieve
the symptoms at home rather than necessary rush in the hospital.
That's clearly a very specific set of circumstances.
The second thing to think about is that you can become aware of your breathing at rest
and it doesn't necessarily mean that it's an abnormal situation.
So, for example, a sense that I want to take a deep breath in and I need to fill my lungs
every now again is not necessary bad sign.
That's often just a variation on a yawn.
If you become aware of your breathing because somebody else is pointed it out to you, that's
not necessarily an abnormal situation.
And if you have an anxiety attack or a panic attack for any reason, then if you become
breathless subsequently as part of that, that's acceptable.
So, sometimes it'll be difficult to unpick, but generally severe breathlessness at rest,
you need to take very seriously - always.
Very frequently I answer that question as yes.
One does need a second opinion because it's often excuse
rather than analysing what's really going on.
So, if you take weight for starters, plenty of people are overweight.
It's not necessarily good for their health, but it doesn't tend to cause breathlessness.
It more causes fatigue on effort or causes joint pains.
As a consequence, a lot of people do stop exercising and do over a period of time also lose fitness.
So, losing fitness can gradually cause you to be unable to exercise and breathless if
you try to exercise.
So, as I previously mentioned, if you significantly reduce your exercise to a low level and then
try to exercise more, you'll often notice that there's breathlessness when you do that.
But if you have been doing your normal things and at this current weight, or relatively
similar weight, you suddenly find you can't do what you were doing, then that is real
breathlessness.
That's not due to the weight.
When it comes to age, there certainly is a gradual loss of one's fitness as you get older.
So, between the ages of 60 and 80, one does lose the ability to do things at speed.
But it's a very gradual thing and most people don't even notice that it's breathlessness
because it happens so, so slowly.
So, if somebody feels more breathless this year than last year, that is not due to age.
Again, some people will keep themselves very fit.
Those people should not find they lose fitness while doing the same level of effort.
In terms of lack of exercise as a cause of breathlessness
what we're looking for here is that the exercise that you would have previously done
and now are not doing is something that you cannot now do when you try to do it.
But if you have been doing the level of exercise you're presently doing, then you should not
lose that due to lack of exercise.