One flight leaves you holding the banister at the top, waiting until you can get a whole sentence out. Being unfit was an easy explanation while you were carrying groceries up, and a harder one the time you were carrying nothing at all. Whether that is a body out of practice or something a clinician needs to look at does not turn on how bad it felt. It turns on how fast it arrived, what you were doing when it did, and whether anything else came with it, and you can check all of that against tonight's flight without leaving the house.
There is no standard definition of difficulty breathing, and it is a subjective feeling: only the person feeling it can decide whether it is present. Some people feel breathless with only mild exercise, climbing stairs among the examples given, without having a medical condition at all. What moves this out of that category is not severity. Breathlessness that comes on suddenly, or that seriously interferes with your breathing and even your talking, is an emergency call. Breathlessness after only slight activity, or at rest, or that is a significant worsening of what stairs normally do to you, is a call to your provider. Neither description asks you to rate anything, which is what makes them usable at the top of the stairs.
Breathlessness with no illness behind it
Breathlessness with no illness behind it is ordinary enough that stairs are the example used for it. Some people feel breathless with only mild exercise (for example, climbing stairs), even though they don't have a medical condition, and the opposite case sits beside it: others may have advanced lung disease and may never feel short of breath. Feeling and illness are not proportional in either direction, which is why no amount of introspection settles this one.
Sometimes mild breathing difficulty may be normal and not a cause for concern, and strenuous exercise is given as an example of that, especially when you do not exercise often. Held against that is a wider instruction from the same place: if breathing difficulty is new or is getting worse, it may be due to a serious problem, and although many causes are not dangerous and are easily treated, contact your health care provider for any breathing difficulty. If you often have trouble breathing, it is important to find out the cause. Neither sentence cancels the other. Together they say that ordinary breathlessness exists and that yours is still worth a call, and the second half is the one people drop.
If the answer does turn out to be a body out of practice, the next step is still not one you take alone. Talk with your healthcare provider before you start a new exercise plan, and discuss how much and what types of physical activity are safe for you. Even modest amounts of physical activity are good for your health. It is the same conversation you were going to have about the stairs anyway.
Sudden, or interfering with your talking
Breathlessness that comes on suddenly, and breathlessness that seriously interferes with your breathing and even your talking, are the two that send you to the emergency room or the local emergency number, along with anyone who has completely stopped breathing. That is the whole of the emergency test, and neither half of it asks how severe it feels.
Below that line sits a longer set of things to see your provider about when they happen alongside breathing difficulty:
- Chest discomfort, pain or pressure, which are symptoms of angina.
- Fever.
- Shortness of breath after only slight activity, or while at rest.
- Shortness of breath that wakes you up at night, or that has you sleeping propped up in order to breathe.
- Shortness of breath with simple talking.
- Tightness in the throat, or a barking, croupy cough.
- Having breathed in or choked on an object.
- Wheezing, which is the high-pitched sound made on breathing out.
- A significant worsening of your baseline shortness of breath.
One flight carrying nothing is slight activity, which puts your last trip up on that list. So does the rest of it: this used to take a load of groceries, and it does not any more.
What else can leave you short of oxygen
What else can leave you short of oxygen is a long grouped list rather than one cause. The mechanism given first is the heart: breathlessness can follow if the heart is unable to pump enough blood to supply oxygen to the body, and the feeling may occur whenever the brain, muscles or other organs do not get enough. The groups are problems with the lungs, including a blood clot in the lung arteries, chronic obstructive pulmonary disease and pneumonia; problems with the airways leading to them; and problems with the heart, including angina, heart attack, heart failure and rhythm disturbances. A final group holds what fits none of those, and obesity, anemia, anxiety, panic attacks, allergies, dust, high altitude and weakness of the breathing muscles are all inside it.
Anemia is worth knowing by name because of what it does rather than what it is called. If you have anemia, your blood does not carry enough oxygen to the rest of your body, and it can leave you feeling tired, cold, dizzy and irritable; you may be short of breath or have a headache. The conditions that may lead to it include heavy periods, pregnancy, ulcers, colon polyps or colon cancer, inherited disorders, a diet without enough iron, folic acid or vitamin B12, and blood disorders; that is an open list of examples rather than the whole set. It is diagnosed with a physical exam and blood tests, so it is not something you can rule in or out from the banister.
What an appointment does with all of that begins with your own account. You will be examined and asked about your medical history and symptoms, and the questions may include how long you have had difficulty breathing and when it started, whether anything makes it worse, and whether you make grunting or wheezing sounds when breathing. Take your own stairs through those beforehand: when it started, whether it has changed since, what makes it worse, and what sound you make at the top. Tests that may be ordered include blood oxygen saturation, blood tests, a chest x-ray, a CT scan of the chest, an electrocardiogram, an echocardiogram, exercise testing and lung function tests. That is a list of what may be done rather than what will be, and which of them applies is decided by whoever examines you.
The page you take to the appointment
- Write when this started, and whether it is new or worse than it used to be. New or getting worse is the pairing that changes how everything else reads.
- Write what you were doing: what you were carrying, how many flights, and whether it happens sitting still too.
- Write how long it takes at the top before you can say a full sentence.
- Write whether it wakes you at night, or whether you have started sleeping propped up.
- Write whether any chest discomfort, pain or pressure comes with it, any fever, any wheeze.
- Take that page to a clinician, and settle how much and what kind of activity is safe for you with the person who has examined you. What that activity is once it is settled is its own question.
- Call the emergency number if breathlessness comes on suddenly, or if it seriously interferes with your breathing and even your talking.
A body out of practice and a body short of oxygen feel the same on the same flight, and no account of how bad it was separates them. What separates them is on the two lists above: how suddenly it came, whether slight activity was enough to do it, whether talking was affected. Write down which of those your last flight met, and the appointment starts from a fact rather than an impression.
