“I can't get enough air” does not describe one condition but a whole range of different mechanisms. The right work begins by identifying which one is at play.
Breathlessness is one of the most common reasons people seek healthcare. Behind the same complaint, however, there may be reduced respiratory muscle strength, air trapping in the lungs, secretions that cannot be cleared, loss of conditioning, cardiac causes or a disordered breathing pattern. The route taken differs in each case.
That is why the first step in respiratory physiotherapy is assessment, not exercise. Which technique suits you depends on your diagnosis, your breathing pattern, your muscle strength and exactly where breathing limits you in daily life.
Sentences I hear often in this group
- “I have to stop and rest going up one flight of stairs.”
- “I have to break my sentences when I'm on the phone.”
- “I fall behind my partner when we walk.”
- “I can't finish the shopping in one go.”
- “I get breathless when I lie down at night, so I raise the pillow.”
- “I panic when I can't breathe, and panicking makes it worse.”
Each of these can point to a different mechanism. The purpose of the assessment is to work out which picture you are dealing with.
What the assessment looks at
- Where the breath is taken from; whether the diaphragm is being used effectively
- Respiratory rate, rhythm and the ratio between inhalation and exhalation
- Whether accessory muscles around the neck and shoulders are active even at rest
- Respiratory muscle strength — by measurement where appropriate
- Chest expansion and posture
- Changes in pulse and oxygen saturation during exertion
- Which activity, what distance or how many steps brings the breathlessness on
- Cough effectiveness and secretions
Medical assessment comes first
The most important point in this group is this: new or increasing breathlessness must be assessed by a doctor first.
Breathlessness can arise from heart failure, arrhythmia, lung conditions, anaemia, thyroid problems and many other causes. A physiotherapist does not diagnose; a doctor makes that distinction. The physiotherapy programme is planned afterwards, within the framework the doctor sets.
If something requiring medical review emerges during assessment — breathlessness at rest, blood in sputum, unexplained weight loss, new chest pain — the programme is postponed and a referral is made.
Treatments used in this group
Respiratory Assessment
Read moreDysfunctional Breathing
Read moreInspiratory Muscle Training (IMT)
Read moreBreathing and Daily Performance
Read moreThe information on this page is for general guidance and does not replace individual advice. A physiotherapist does not diagnose; they assess and plan a programme within the framework of medical referral. Which techniques are suitable for you is determined through a face-to-face respiratory assessment. Please consult your doctor and physiotherapist before starting.
Sudden or rapidly worsening breathlessness, chest pain, bluish discolouration of the lips or nails, or confusion may signal an emergency. Do not attempt exercises in such a situation; call the emergency number (112 in Türkiye) or go to the nearest emergency department without delay.
Frequently Asked Questions
Usually respiratory medicine or cardiology is the starting point; depending on the nature of the symptom your family doctor can point you in the right direction. Respiratory physiotherapy comes into play after that assessment.
Normal imaging and tests do not mean respiratory muscle strength, conditioning and breathing pattern are also normal. Those three do not show on tests but are felt in daily life. A respiratory assessment may be worthwhile in that situation.
That depends on the underlying cause and no promise can be made. Where there is chronic lung disease, the aim is not to remove the condition but to do more in daily life with the capacity you have.