Breathlessness is a symptom with many possible causes. A clinician will ask about the speed of onset, what triggers it, associated symptoms (cough, wheeze, ankle swelling, chest pain), and your medical history. Lung function tests (spirometry), a chest X-ray, blood tests including BNP (for heart failure), and an ECG are common first-line investigations. In some cases, exercise testing, CT of the chest, or echocardiogram may be needed.

COPD (chronic obstructive pulmonary disease) is a progressive, irreversible condition causing breathlessness, cough, and sputum production. It is caused almost entirely by smoking (in 85–90% of cases) and by long-term occupational dust and fume exposure. Asthma is a reversible inflammatory condition typically beginning in childhood or young adulthood, characterised by variable breathlessness and wheeze triggered by allergens, cold air, exercise, or infection. COPD cannot be reversed; asthma can be well-controlled and is often reversible. An important overlap condition (ACOS — asthma-COPD overlap syndrome) requires specialist assessment.

Heart failure causes breathlessness by causing fluid accumulation in the lungs (pulmonary oedema). The earliest symptom is breathlessness on exertion — initially on significant exercise, progressively on less activity. As heart failure worsens, breathlessness occurs at rest and lying flat (orthopnoea) — patients sleep with multiple pillows. Waking at night gasping (paroxysmal nocturnal dyspnoea) is a classic sign. Associated ankle swelling, fatigue, and weight gain from fluid retention are common. Heart failure is diagnosed by BNP blood test and echocardiogram and treated with ACE inhibitors, beta-blockers, diuretics, and SGLT2 inhibitors.

Pulmonary fibrosis is scarring of the lung tissue that causes progressive, irreversible breathlessness. The most common form is idiopathic pulmonary fibrosis (IPF), which predominantly affects people over 60. Symptoms include gradual breathlessness on exertion, a dry persistent cough, and ‘velcro crackles’ at the lung bases on examination. CT chest is the key investigation. Anti-fibrotic medications (nintedanib, pirfenidone) slow disease progression but do not reverse existing scarring. Lung transplantation is considered in eligible patients with advancing disease. Breathlessness that is gradually worsening over months without asthma or COPD should always prompt investigation for fibrosis.

Yes. Hypertension in pregnancy — particularly pre-eclampsia (hypertension with proteinuria after 20 weeks) — is a serious condition affecting 2–5% of pregnancies. It can cause maternal complications (seizures, stroke, organ failure) and fetal growth restriction or preterm birth. Safe antihypertensives in pregnancy include labetalol, nifedipine, and methyldopa. ACE inhibitors and ARBs must be avoided in pregnancy due to fetal toxicity. Women with pre-existing hypertension should have their medication reviewed before or at the start of pregnancy.

The most common causes of bilateral ankle swelling are venous insufficiency (varicose veins and poor venous return), medications (particularly calcium channel blockers such as amlodipine), and inactivity. Heart failure is an important cause that must be excluded, particularly if accompanied by breathlessness. Bilateral swelling is rarely DVT — DVT almost always affects one leg at a time. If both ankles swell consistently at the end of the day and improve overnight, venous insufficiency and medication side effects are the most likely explanations.

Post-thrombotic syndrome (PTS) is a complication affecting 20–50% of people after DVT, causing chronic pain, swelling, skin changes, and — in severe cases — venous ulceration in the affected leg. It results from valve damage in the deep veins caused by the clot. The most effective prevention is wearing correctly fitted class 2 graduated compression stockings for at least 2 years after DVT. Early ambulation after DVT (walking is safe and beneficial), adequate anticoagulation, and compression therapy all reduce the risk. Severe PTS may require specialist vascular assessment.

Lymphoedema is chronic, progressive swelling caused by damage to the lymphatic system. Unlike pitting oedema from venous causes, lymphoedema is typically non-pitting, affects the foot and toes (not just the ankle), and does not improve with overnight elevation. Common causes include cancer treatment (lymph node removal or radiotherapy), infection (particularly recurrent cellulitis), and primary lymphatic abnormalities. It is managed — not cured — with complex decongestive therapy (manual lymphatic drainage, compression garments, skin care, and exercise). Early specialist referral to a lymphoedema clinic is important.