Leaflet 5: Thinking - Managing Thoughts About Breathlessness

Breathlessness Intervention Service

The information given below is designed to help you manage your stable long-term breathlessness. If your breathing is getting worse, or you are experiencing breathlessness as a new feeling, it is important to seek medical advice from your GP.

Breathlessness is a very common symptom in many long-term conditions such as COPD, heart failure, and cancer. It is normal to become breathless when we exercise or exert ourselves. However, there are times that breathlessness can feel uncomfortable or worrying.

How the Brain Responds to Breathlessness

Sudden and unusual breathlessness can be a sign that something is wrong. Our brain responds to this by triggering our survival or ‘fight or flight’ response. When this happens, the body is preparing itself to react and protect us. This response is helpful in dangerous situations but less so with day-to-day breathlessness.

When the fight or flight response is triggered, you might experience some of the following:

• Body: Tensed muscles, rapid heartbeat, difficulties breathing, chest pains, sweating, dizziness, nausea, dry mouth, blurred vision, or the need to go to the toilet.
• Thoughts: Unhelpful thinking such as imagining the worst, worrying about looking foolish, worrying about ‘going mad’.
• Actions: Avoiding situations or people which make you feel anxious, poor concentration, aggression, irritability, sleep problems.

Our fight or flight response can also be triggered when we feel frightened or anxious. It is normal to experience some degree of anxiety from time to time. However, when anxiety is triggered by day-to-day breathlessness, it can be less helpful.

Breathlessness and Anxiety

Unhelpful thoughts about breathlessness can often lead to a cycle of anxiety and avoidance. When anxiety begins to affect life to an extent that you are experiencing unpleasant symptoms regularly, it is helpful to understand the reasons why this is happening, so that you can manage these symptoms.

“I’m in control of what’s happening to me, you know, how I feel mentally, not necessarily physically all the time, but certainly mentally I’ve got a much different attitude.”

Some people find it reassuring to know that usual day-to-day breathlessness on exertion is not harmful. There are ways to manage breathlessness which help you to recover more quickly.

Common Thoughts About Breathlessness

Feeling breathless, or seeing someone you care about being breathless, can be very unpleasant and frightening. Understanding why breathlessness happens, how the body responds, and how you can control these responses can be a very useful way of managing your breathlessness.

Here are some common thoughts or 'misconceptions' which people often have about breathlessness:

• “I need more oxygen”: Breathlessness is not always related to the level of oxygen in your blood, and oxygen does not always relieve breathlessness. Using a fan and practising relaxed tummy breathing will help your breathing.
• “I won’t be able to get my breath back”: Breathlessness from being active will ease when you rest. Slowing down and pacing yourself may help keep the breathlessness at a comfortable level.
• “I’m going to pass out”: Over breathing can make you feel light-headed. Slowing your breathing by using one of the breathing exercises can prevent this from happening.
• “I’m going to have a stroke or heart attack”: Understanding the body’s response to breathlessness and anxiety can help to take away these worrying thoughts.

How Can I Control My Anxiety?

• Recognise what triggers your anxiety and the first signs you notice.
• Use a technique that helps at the first sign of anxiety.
• Try to identify problems and address them one at a time.
• Learn a way of relaxing that works for you.
• Use a photo or picture that helps you to think about relaxing thoughts.
• Talk about how you are feeling to a relative, friend, or healthcare professional.

Thoughts about breathlessness can influence your feelings and actions. Talking these situations through with a healthcare professional can help you to change your responses to situations.

Having a Plan of Action

Many people find it helpful to have a plan of action written down to refer to. This action plan may be as simple as a few basic prompts to remind you what can be helpful.

• I have had this feeling before
• I know it will go away soon
• I am going to lean forward
• I am going to use my fan
• Focus on gently breathing out
• I can do this – I am doing it now
• I don’t need to be frightened – I am OK

Further Information

For further help or advice contact the Breathlessness Intervention Service on 01223 274404 - 09:00 (9am) to 17:00 (5pm) Monday to Friday.

For advice and support in quitting smoking, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page or telephone 01223 256998.

Cambridge University Hospitals NHS Foundation Trust
Hills Road, Cambridge CB2 0QQ
Telephone +44 (0)1223 245151

This document was correct at the time of printing - 18-03-2025 09:31