Breathlessness has been described as "an uncomfortable need to breathe." We all become breathless on exertion, but it is debilitating if it occurs at very modest levels of exertion, or even at rest. Such unaccustomed breathlessness is due to one of a variety of causes, many or most of them amenable to treatment. Although it can occur more often as we get older, it should NOT be considered a normal part of ageing.

LUNG DISEASE ·

Obstruction to the small air passages (asthma, bronchitis, emphysema) · Disease of the lungs themselves (usually producing stiffening) · Excess fluid around the lung · stiffening of the rib cage

HEART DISEASE

This includes disturbances of the rhythm of the heart that affect the way it functions.

ANAEMIA AND OBESITY

These conditions both place an extra load on the heart.

Incidence
The true incidence of breathlessness in the older generation is not easy to define, partly because many regard breathlessness as something to be expected in normal old age. However, a fit older individual should not be breathless on slight exertion.

Several recent studies have found that about a quarter of older people will report breathlessness at rest or on varying degrees of exertion. The true figure may be even greater than one in four because people ( perhaps particularly the old) tend to avoid activities which make them breathless. In one study over 40% of the incidence of breathlessness was thought to be due to heart disease, the same proportion to smoking-related lung disease, and in the remaining 16% to other lung disease.

Current treatment
Treatment will depend on the cause of breathlessness. The first priority, therefore, is for a doctor to diagnose the cause so that a decision can be made on appropriate treatment. This will usually involve an X-ray of the chest, and perhaps a heart test (electrocardiogram), and blood tests. Many of the causes of breathlessness are wholly or partly reversible by relatively simple tablet or inhaler treatment. Of particular importance are the degree to which obstruction to the small airways can be reversed (to a large extent in asthma, to a lesser extent in bronchitis or emphysema), the presence of a disturbance of the rhythm of the heart, and anaemia, both of which can be relatively easily treated. If the cause of the breathlessness cannot be completely treated, there are still ways in which you may be able to help yourself:

Stop or greatly cut down on smoking tobacco. This can be of use even in long-standing smokers, whatever they smoke and whatever their age. Many people notice an increase in weight when they stop smoking, but this should not be used as a reason not to give up, as the weight gain usually stabilises after a few months. It is much healthier to be a little overweight than to smoke even a few cigarettes a day.

If you are considerably overweight, reduce your weight to a level at which you feel comfortable.

·Take regular exercise (brisk walking is the best), at a pace which makes you slightly but not unduly breathless. Do not be too ambitious, but gradually increase the distance you cover, or the time for which you walk. Do not be embarrassed if you need to stop and rest. Remember that breathlessness is uncomfortable, but not harmful.