Struggling for breath is one of the most frightening symptoms there is — and one where time matters most. Some kinds of breathlessness mean calling the emergency services within the minute; others build up slowly, over weeks, and deserve to be investigated without panic. Here is how to tell the difference.
When to call 101 immediately
Call 101 (Magen David Adom) without delay if any of these signs is present:
- sudden breathlessness, coming on within minutes, without exertion;
- difficulty speaking: broken sentences, only a few words between breaths;
- blue-tinged lips, face or nails;
- breathlessness with chest pain, sweating or feeling faint;
- intense wheezing that does not respond to the usual asthma treatment;
- confusion, unusual drowsiness or unusual agitation.
In a child, also watch for: the skin pulling in between the ribs or below the ribs with each breath, flaring of the nostrils, a grunting sound on breathing out, or a child too breathless to drink or feed.
What “being breathless” means
Breathlessness — shortness of breath — is not a disease but a signal. It reflects a mismatch between the oxygen the body needs and what breathing and circulation can supply. Hence the wide range of causes: they can come from the lungs, the heart, the blood, or the nervous system and anxiety.
Two questions point the way in almost every case: since when? and in what circumstances? Breathlessness that appeared within an hour is not managed like breathlessness that has been worsening for six months.
The most common causes
Depending on how quickly it sets in, the first things to consider are:
- sudden (minutes): asthma attack, pulmonary embolism, fluid on the lungs (pulmonary oedema), pneumothorax (collapsed lung), an inhaled foreign body, panic attack;
- rapid (hours to days): respiratory infection, pneumonia, bronchitis, worsening heart failure, acute anaemia;
- gradual (weeks to months): anaemia, heart failure, COPD (the chronic lung disease of smokers), poorly controlled asthma, excess weight, being out of condition, thyroid disease.
Two causes are often overlooked yet very common: anaemia, particularly in women with heavy periods, and being out of condition after several weeks without activity — breathlessness on exertion is then not a disease, but it deserves to be confirmed as such rather than assumed.
Breathlessness or anxiety?
A panic attack causes genuine breathlessness: rapid, shallow breathing, chest tightness, tingling in the hands and around the mouth, a feeling of impending death. These symptoms are real, not imaginary.
But anxiety is never the first diagnosis to be made, especially from your forties onwards or when risk factors are present: a pulmonary embolism and a heart attack can present exactly this way. The rule is to rule out what is serious first, then treat the anxiety — which also deserves proper care.
When to see a doctor the same day
In the absence of the emergency signs, see a doctor the same day if:
- the breathlessness is new and interferes with everyday activities — climbing a flight of stairs, walking, talking;
- it comes with a fever, a cough or discoloured phlegm;
- it wakes you at night or forces you to sleep propped up on several pillows;
- your ankles are swelling or you have gained weight quickly;
- you are pregnant, immunocompromised, or you have a known heart or lung condition;
- you are coughing up blood, even in small amounts — this sign calls for immediate medical advice;
- it comes on in the days after a long journey, a period of immobility or recent surgery: this setting raises the question of a blood clot in the lungs — see a doctor without delay, and at the slightest associated sign (pain on breathing, coughing up blood, feeling faint, a swollen, painful calf), call 101.
What a doctor looks for
The examination is quick and simple: listening to the lungs and heart, measuring oxygen saturation on a fingertip, checking the heart rate and blood pressure, looking for swelling in the legs. Depending on the situation, a blood test, an electrocardiogram or a chest X-ray may be added.
It is little in itself, but it is most often enough to distinguish between the main causes — and above all to know whether immediate action is needed.
Seeing Dr Nathalie Gozlan
Dr Nathalie Gozlan, a general practitioner and a specialist in emergency medicine, sees patients with breathlessness that needs investigating: examination, oxygen saturation, referral and follow-up — as a home visit across the Sharon region (Netanya, Kfar Saba, Raanana, Kadima-Tzoran, and the moshavim and kibbutzim of the area), or by video consultation anywhere in Israel, in English, Hebrew and French.
Sudden breathlessness or difficulty speaking cannot be assessed remotely: call 101.
Frequently asked questions
Is it normal to get breathless climbing the stairs?
That depends on what is usual for you. Breathlessness that appears on an effort you managed without difficulty a few weeks ago is not normal and should be investigated. Breathlessness that has always been there, is proportionate to the effort and settles quickly with rest is most often a matter of fitness — but anaemia is common and can be detected with a simple blood test.
How can I tell whether it is the heart or the lungs?
A few pointers: breathlessness that wakes you at night, forces you to sleep sitting up or comes with swollen ankles points towards the heart; wheezing, a cough and phlegm point towards the lungs. These pointers are not enough to settle the question: an examination, an oxygen saturation reading and often a blood test are needed.
Can breathlessness be caused by stress?
Yes, and the symptoms are real. But that diagnosis is made only after cardiac and lung causes have been ruled out, never before — especially after 40 or when risk factors are present. Once everything else has been excluded, the anxiety can be treated, and it deserves to be taken seriously.
Can breathlessness be assessed by video consultation?
For breathlessness that is long-standing, stable or occurs only on exertion, yes: the history tells a great deal, and a video consultation makes it possible to decide which tests are useful. For breathing difficulty happening right now, no — listening to the lungs and measuring the oxygen saturation are essential, and a home visit or the emergency department is required. Faced with sudden breathlessness, the right number is 101.
