When to get urgent help

Call 999 if you:

have severe difficulty breathing or cannot speak in full sentences
have chest tightness or heaviness, or pain spreading to your arms, back, neck or jaw
have pale, blue or grey lips or skin
become suddenly confused

Do not drive yourself to A&E.

Contact NHS 111 the same day if your breathing is worse than usual, or if you are breathless and also cough up blood, have pain or swelling in one leg, or notice palpitations (a racing, slow or skipping heartbeat). Do not wait for a routine clinic appointment.

What is breathlessness?

Breathlessness (dyspnoea) is an uncomfortable awareness of your breathing. Getting out of breath with hard exercise is normal. A change from what is normal for you – for example, becoming breathless on stairs you used to manage easily – deserves assessment.

Breathlessness lasting more than eight weeks is often called chronic breathlessness. In many people, more than one factor contributes.

Common causes

Lungs and airways: asthma, COPD, interstitial lung disease, bronchiectasis, pulmonary embolism, pleural effusion
Heart: heart failure, valve disease, rhythm problems such as atrial fibrillation
Other factors: anaemia, thyroid disease, reduced fitness, excess weight, dysfunctional breathing, anxiety

Less common causes, such as pulmonary hypertension or muscle weakness, are considered if the first tests do not explain your symptoms.

How we assess breathlessness

Your history – when it started, what brings it on, how far you can walk, whether lying flat or waking at night makes it worse, smoking, work exposures and medicines.
Examination – including oxygen levels at rest and, where helpful, during walking.
First tests, chosen for you – these may include blood tests (including a full blood count (FBC) to check for anaemia, and NT-proBNP, a marker of heart strain), an ECG, a chest X-ray, spirometry or full lung function tests, and FeNO.
Further tests if needed – a CT scan of the chest, an echocardiogram, heart rhythm monitoring or cardiopulmonary exercise testing (CPET).

Not everyone needs every test. We explain the results and agree a plan with you.

Cardiopulmonary exercise testing (CPET)

CPET measures how your heart, lungs and muscles work together while you cycle on an exercise bike. It records your peak oxygen uptake (VO₂ max), carbon dioxide output (VCO₂), anaerobic (metabolic) threshold, breathing pattern, heart rate and ECG. When other tests have not given a clear answer, it can help show whether breathlessness is mainly related to the lungs, heart, circulation, breathing pattern or fitness. Read what happens during CPET.

Treatment and self-management

Treatment depends on the cause – for example, inhaled treatment for asthma or COPD, or cardiology review for a heart condition. For ongoing breathlessness, these can also help:

pulmonary rehabilitation – supervised exercise and education for long-term lung conditions
breathing control and recovery techniques
pacing activities and planning ahead
positions that ease breathing, such as leaning forward with your arms supported
a handheld fan directed towards your face
stopping smoking, with support from NHS Stop Smoking Services
support for anxiety, which often accompanies breathlessness

Oxygen helps people whose oxygen levels are low. It is not routinely helpful for breathlessness when oxygen levels are normal.

Preparing for your appointment

Bring a list of your medicines and inhalers.
Bring previous test results, letters and scan reports.
Note when you get breathless and what helps.

Sources and further information

This guide gives general information for adults and does not replace individual medical advice.