ON THE COVER Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
If you’re out of breath more often than you were, it’s easy to assume it’s your lungs to blame, but there could be a surprising number of other causes.
Let’s start with your lungs. The most common cause of childhood breathlessness is asthma, affecting at least 1 in 10 children and 1 in 20 adults. Many children grow out of it. However, adults can develop asthma too, sometimes as a result of exposure to chemical irritants at work. This is more likely if symptoms improve at weekends or on holiday. Treatment is usually with a combination of avoiding triggers, “reliever” inhalers (which open up the airways) and regular “preventer” inhalers (which reduce inflammation).
The chronic lung condition COPD is usually but not always down to smoking. Along with breathlessness that gets worse with exercise, you’ll often have a chronic cough and bring up sputum. COPD makes you prone to chest infections, which can worsen breathing difficulty. Stopping smoking is key, regardless of the severity of the condition – it really is never too late! Lung fibrosis can occur as a result of exposure to asbestos or even birds – so called “pigeon fancier’s lung”. You’ll get a tickly cough and breathlessness that can’t be explained by other factors. It’s much less common than asthma or COPD. Your lungs take in oxygen, but it’s your arteries that carry it to the organs of your body and your heart that pumps it there. That’s why abnormal heart rhythms, which affect your heart’s pumping efficiency,
can cause breathlessness. Other clues include palpitations and feeling as if you’re going to faint, or actually blacking out. Treating the abnormal heart rhythm gets the heart pumping more effectively. The most common abnormal heart rhythm in the UK is Atrial Fibrillation or AF, which affects over 1 million UK adults and gets more common with age. Along with breathing difficulty, it greatly increases your risk of stroke. This can be managed effectively with blood thinning agents which you take regularly – it’s essential to keep taking these.
Leaky or creaky valves connecting the chambers of your heart can also cut the amount of blood it can pump. This leads to shortness of breath when you exert yourself, and may be accompanied by chest pain or feeling faint. Your doctor can confirm this with a heart scan called an echo. Medication or surgery may be needed.
Your blood carries oxygen by linking it to a chemical called haemoglobin, found in your red blood cells. Lack of haemoglobin, or anaemia, can be down to all sorts of causes, including heavy periods in women before menopause, blood loss, not enough iron in your diet or long term problems with your kidneys, liver etc. Blood disorders like chronic leukaemia can also leave you anaemic.
In heart failure, the heart is weakened and can’t pump blood round your system efficiently. This leads to fluid building up in legs and lungs, with swollen ankles and breathlessness when you lie flat or exercise. Treatments for heart failure have moved on dramatically recently, relieving symptoms and stopping them returning.
Finally, anxiety can lead to breathless – your brain tells you you’re short of oxygen when you aren’t. Counselling for underlying causes usually works very well. Next week: How dangerous is sepsis?