Understanding Breathlessness

The quantity and quality of our breathing is closely linked to our physical and mental well-being.

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Our breathing has always been intimately linked to our sense of physical wellbeing and mental health. The last 12 months have brought an almost daily focus to breathing problems as we battle the COVID-19 pandemic. Who hasn’t at times recently thought about their breathing rate or oxygen levels? Many have even purchased home oxygen monitoring devices (pulse oximetry) to feel more secure. The concern about our breathing does not just rest with worries about contracting COVID-19 – for some of those who are recovering from the illness, breathlessness has become a persistent and disabling symptom, preventing return to normal daily life.

Whilst breathlessness can be a worrying and debilitating symptom, it is also something we all experience when we undertake vigourous exercise. In that sense, the symptom is often an issue of quantity – in other words the amount of exercise provoking shortness of breath is the concern. This makes understanding our breathing problems complex. Whilst breathlessness can be an indication of a serious lung or heart problem, simple loss of fitness can also underlie the symptom. Social lockdown has had serious impacts on physical activity and fitness, particularly for those shielding because of significant underlying health problems and increased breathlessness is sometimes the result.

We can all recognise that our breathing is affected by anxiety and stress – sometimes severely, leading to panic like symptoms. These episodes can be frightening and produce other physical symptoms such as pins and needles in the lips and fingers and light-headedness. This is often down to the way we regulate our breathing. The part of the brain that controls the depth and rate of breathing can be overridden by our conscious mind (we can choose to hyperventilate if we want to) and overcompensation for perceived breathing problems by increasing our breathing rate can make the problem worse. This is a common problem in people with conditions such as asthma but I think is happening more during the pandemic – perhaps because, as I mention above, breathing is rarely out of the news at the moment.

Most significant health problems causing breathlessness (such as lung or heart disease) can be picked up with simple blood tests, x-rays and breathing tests. However, sometimes more complex investigations are warranted if the cause is not found. Sometimes a medical cause is not found and whilst this can be frustrating, particularly if the symptom is limiting physical activity, the reassurance that it’s not due to a serious problem or due to low oxygen levels can help people return to normal activities and take steps to restore their physical fitness.