Breathing Problems: Causes and When to Get Help

Types of breathing problems

Describing exactly what you notice helps narrow down the cause.

Common causes of breathing problems

Asthma

Asthma causes episodes of wheezing, chest tightness, breathlessness and coughing, often at night or early morning, and triggered by exercise, cold air, allergens, smoke or colds. Symptoms improve with a reliever inhaler.

Chest infections

Acute bronchitis, pneumonia, flu and COVID-19 cause breathlessness with cough, fever and phlegm. Pneumonia is more likely with high fever, fast breathing, chest pain and feeling very unwell.

COPD

Chronic obstructive pulmonary disease mainly affects current and former smokers over 40. It causes slowly worsening breathlessness on exertion, a daily cough with phlegm, and flare-ups with infections.

Allergies

Hay fever blocks the nose and can trigger asthma. Severe allergic reactions (anaphylaxis) cause throat swelling, wheezing and collapse within minutes.

Anxiety and hyperventilation

Panic and anxiety cause rapid breathing, a feeling of not getting a full breath, tingling in the fingers and around the mouth, chest tightness and dizziness. Oxygen levels are normal. It is a diagnosis made only after physical causes are considered.

Obesity and low fitness

Extra weight and deconditioning make the lungs and muscles work harder, so ordinary activity feels breathless. This improves with gradual exercise and weight loss.

Serious causes

• Heart failure: breathlessness on exertion and lying flat, waking up gasping, ankle swelling and fatigue.
• Heart attack: breathlessness can be the main symptom, especially in women, older adults and people with diabetes.
• Pulmonary embolism: a blood clot in the lungs causes sudden breathlessness, sharp chest pain and sometimes coughing blood. Risk rises after surgery, long travel, pregnancy, cancer or a leg clot.
• Pneumothorax: a collapsed lung, with sudden one-sided chest pain and breathlessness, in tall young people or those with lung disease.
• Severe anemia: breathlessness and tiredness with pale skin.
• Lung fibrosis and lung cancer: gradually worsening breathlessness and cough.

Breathing problems in children

Children's airways are small, so swelling causes trouble quickly. Watch for:

• Croup: barking cough and stridor, worse at night, in young children
• Bronchiolitis: wheeze and fast breathing in babies under 2, usually from RSV
• Choking or an inhaled object: sudden coughing and noisy breathing during play or eating
• Signs of distress: flaring nostrils, grunting, skin sucking in between or below the ribs, head bobbing, or too breathless to feed

How doctors find the cause

Your doctor will ask how fast the breathing problem came on, what triggers it, whether you are breathless at rest or only on exertion, and about smoking, allergies, heart disease and medicines. They will check your oxygen level with a finger probe, listen to your chest and heart, and look for swelling in the legs.

Common tests:

• Pulse oximetry: measures oxygen saturation; normal is usually 95% to 100%
• Peak flow and spirometry: measure airway narrowing for asthma and COPD
• Chest x-ray: shows pneumonia, fluid, a collapsed lung or masses
• ECG and echocardiogram: check the heart
• Blood tests: blood count for anemia, BNP for heart failure, D-dimer when a clot is possible
• CT scan: for suspected blood clots or lung disease

What helps breathing problems

In the moment

• Sit upright, leaning slightly forward with your arms resting on a table or your knees.
• Use your reliever inhaler if you have one, with a spacer if available.
• Try pursed-lip breathing: breathe in through your nose for 2 counts, out through pursed lips for 4.
• Loosen tight clothing and get fresh air, but avoid cold air if it triggers your asthma.
• If you have an epinephrine auto-injector and signs of anaphylaxis, use it and call 911.

Longer term

• Stop smoking and avoid secondhand smoke.
• Take preventer inhalers regularly as prescribed, even when well.
• Get flu, COVID-19, pneumococcal and RSV vaccines as recommended for your age and health.
• Pulmonary rehabilitation improves breathlessness in COPD and other lung diseases.
• Lose weight and build fitness gradually.
• Have your inhaler technique checked: many people use inhalers incorrectly.

Frequently asked questions

When should I worry about breathing problems?

Call 911 if breathing difficulty is sudden or severe, if your lips turn blue, if you cannot speak in full sentences, or if it comes with chest pain, fainting or swelling of the face or throat. See a doctor soon for breathlessness that is new, worsening or waking you at night.

What causes breathing problems at night?

Asthma often worsens at night. Heart failure causes breathlessness when lying flat and waking up gasping. Acid reflux, sleep apnea, a blocked nose and anxiety are other causes. Waking breathless regularly needs a medical review.

Can anxiety cause breathing problems?

Yes. Anxiety and panic cause fast, shallow breathing, a feeling of air hunger, chest tightness and tingling. Oxygen levels stay normal and symptoms settle as the anxiety passes. Because other causes can feel similar, get a medical check if this is new.

What is a normal oxygen level?

A normal oxygen saturation measured by a finger probe is usually 95% to 100% at sea level. A reading below 92% to 94% needs medical attention in most people. Some people with COPD have a lower personal target set by their doctor.

How can I breathe better quickly?

Sit upright and lean forward, slow your breathing, and use pursed-lip breathing: in through the nose, then out slowly through pursed lips. Use your reliever inhaler if you have asthma or COPD. If breathing does not improve quickly or is severe, call 911.