Breathlessness is one of the most distressing and frequently misattributed symptoms in respiratory medicine. Many patients are reassured with a normal chest X-ray or told their breathlessness is anxiety-related without the systematic investigation needed to identify what is truly causing it. Breathlessness has a broad differential diagnosis, spanning respiratory, cardiac, haematological and metabolic causes, and in many patients more than one mechanism is contributing simultaneously. Dr Sundeep Kaul provides a thorough, structured investigation of breathlessness, drawing on his expertise in both respiratory medicine and general internal medicine to find the underlying cause and build a management plan that directly addresses it.
What Causes Breathlessness?
Dyspnoea — the medical term for breathlessness — is the subjective sensation of difficulty breathing or an unsatisfied need for air. It is a symptom rather than a diagnosis, which means identifying the cause requires a systematic clinical assessment rather than a single test. Common respiratory causes include asthma, COPD, pulmonary fibrosis, pleural effusion, pulmonary embolism and hyperventilation syndrome. Cardiac causes include heart failure, arrhythmia, valve disease and pericardial effusion. Anaemia, thyroid disease and deconditioning can also produce or worsen breathlessness significantly. The breadth of this differential is precisely why a specialist with dual training in respiratory medicine and general internal medicine as Dr Kaul holds is best placed to investigate unexplained breathlessness comprehensively and reach the correct diagnosis efficiently.
Symptoms May Include
- Shortness of breath on exertion
- Breathlessness at rest or when lying flat
- Sensation of chest tightness or air hunger
- Feeling unable to take a full or satisfying breath
- Rapid or shallow breathing
- Breathlessness waking you from sleep
- Reduced ability to complete everyday activities
- Worsening symptoms with physical activity or climbing stairs
- Associated cough, wheeze or chest pain
- Breathlessness that has gradually worsened over months
Diagnostic Assessment
Your consultation may include:
- Detailed breathlessness history — onset, pattern, triggers and progression
- Full clinical examination including cardiovascular and respiratory assessment
- Spirometry and comprehensive lung function testing including diffusion capacity (DLCO)
- FeNO measurement — to identify eosinophilic airway inflammation
- Chest X-ray and high-resolution CT chest where indicated
- ECG and echocardiogram — to assess for cardiac contribution
- Blood tests including full blood count, BNP, thyroid function, D-dimer and iron studies
- Cardiopulmonary exercise testing (CPET) — for unexplained or exercise-related breathlessness
- Referral to cardiology colleagues where a cardiac cause is identified or suspected
Treatment Approach
Treatment is directed at the identified underlying cause and is personalised to each patient’s clinical picture. It may include:
- Inhaler therapy for asthma- or COPD-related breathlessness
- Pulmonary rehabilitation and supervised graded exercise
- Breathing retraining and physiotherapy referral
- Diuretic therapy for fluid overload contributing to breathlessness
- Anticoagulation for confirmed pulmonary embolism
- Pleural drainage procedures where pleural effusion is identified
- Correction of anaemia, thyroid dysfunction or other systemic causes
- Co-ordinated management with cardiology, haematology or neurology as required
Why Early Assessment Matters
Breathlessness may signal serious but treatable conditions. Early specialist assessment helps identify the cause, avoid delays, and guide effective treatment.
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