Practical Answers for Everyday Independence

Responding to Serious Difficulty Breathing or an Asthma Attack – QG

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Category: Health & Safety

⚡ Responding to Serious Difficulty Breathing or an Asthma Attack

Serious difficulty breathing can be caused by asthma, an allergic reaction, choking, infection, heart problems, smoke, chemicals, an overdose, or another medical emergency.

Do not assume that every breathing problem is asthma. If the person is struggling to breathe, cannot speak normally, appears blue or gray, becomes confused, or is getting worse quickly, call 911.

Call 911 Immediately If

  • The person cannot speak in complete sentences.
  • Breathing is extremely difficult, fast, slow, or irregular.
  • The person is gasping.
  • Lips, face, or fingertips appear blue, gray, or extremely pale.
  • The chest or neck pulls inward with each breath.
  • The person becomes confused, drowsy, or unresponsive.
  • The person collapses.
  • A rescue inhaler is not helping.
  • The person does not have their prescribed rescue medication.
  • The breathing problem began after a sting, food, medication, or other possible allergen.
  • Choking, overdose, smoke inhalation, or chemical exposure may be involved.
  • The person has severe chest pain or pressure.
  • This is the person’s first severe breathing episode.
  • You are unsure whether the person is safe.

Do not delay calling while searching for medication.

Help the Person Breathe More Easily

  • Keep the person sitting upright.
  • Allow them to lean slightly forward if that feels easier.
  • Loosen tight clothing around the neck and chest.
  • Move away from smoke, fumes, pets, cold air, or other triggers when safe.
  • Keep the area calm.
  • Encourage slow, steady breathing.
  • Stay with the person.
  • Follow the 911 dispatcher’s instructions.

Do not force someone who is struggling to breathe to lie flat.

Signs of an Asthma Attack

Possible signs include:

  • Wheezing
  • Coughing
  • Chest tightness
  • Shortness of breath
  • Rapid breathing
  • Difficulty speaking
  • Needing to stop during ordinary activity
  • Tightening of the muscles in the neck or chest
  • Reduced peak-flow reading
  • Anxiety or panic caused by difficulty breathing

A severe asthma attack may produce very little wheezing because not enough air is moving. A suddenly quiet chest is not necessarily an improvement.

Help With a Rescue Inhaler

If the person has a prescribed rescue inhaler:

  1. Help them sit upright.
  2. Find their asthma action plan if available.
  3. Check that you have the correct inhaler.
  4. Remove the cap.
  5. Shake the inhaler if its instructions require it.
  6. Attach a spacer if available.
  7. Help the person take the medication exactly as prescribed.
  8. Follow the action plan for additional doses.
  9. Call 911 if symptoms are severe, worsening, or not improving.

A spacer can make it easier for medication to reach the lungs. Follow the inhaler and spacer instructions.

Do not use another person’s prescription inhaler unless a healthcare professional or emergency dispatcher specifically directs you to do so.

If a Nebulizer Is Prescribed

If the person’s asthma plan includes a nebulizer:

  • Use only the prescribed medication.
  • Follow the equipment instructions.
  • Keep the person sitting upright.
  • Monitor breathing throughout treatment.
  • Do not delay calling 911 when symptoms are severe.
  • Do not assume the person is safe because treatment has started.

A severe attack may require oxygen, repeated medication, or other emergency treatment.

If an Allergic Reaction May Be Causing the Breathing Problem

Signs of anaphylaxis may include:

  • Difficulty breathing
  • Wheezing
  • Swelling of the tongue, lips, or throat
  • Widespread hives
  • Trouble swallowing
  • Repeated vomiting
  • Severe dizziness
  • Fainting
  • Rapidly worsening symptoms

If prescribed epinephrine is available:

  1. Use it immediately according to the device instructions.
  2. Call 911.
  3. Keep the person in a safe position.
  4. Give a second dose after the prescribed interval if symptoms continue and another device is available.
  5. Monitor breathing.
  6. Begin CPR if the person becomes unresponsive and is not breathing normally.

Do not delay epinephrine while waiting for an antihistamine or inhaler to work. An inhaler does not replace epinephrine during anaphylaxis.

If Choking May Be Involved

Ask, “Are you choking?”

If the person can cough forcefully or speak:

  • Encourage coughing.
  • Stay nearby.
  • Do not give food or water.
  • Watch for worsening symptoms.

If the person cannot speak, cough effectively, or breathe:

  • Call 911.
  • Begin appropriate choking first aid according to your training.
  • Continue until the object comes out or the person becomes unresponsive.

If the person becomes unresponsive, begin CPR and use an AED when available.

If an Opioid Overdose May Be Involved

Possible signs include:

  • The person cannot be awakened.
  • Breathing is slow, irregular, or stopped.
  • The body is limp.
  • Pupils are extremely small.
  • Lips or fingertips appear blue, gray, or pale.
  • The person makes choking, gurgling, or unusual snoring sounds.

If an opioid overdose is possible:

  1. Call 911.
  2. Give naloxone.
  3. Begin rescue breathing or CPR according to your training.
  4. Give another naloxone dose after the recommended interval if needed.
  5. Stay until emergency responders arrive.

Naloxone does not replace CPR or emergency medical care.

If Smoke or Chemicals May Be Involved

  • Move to fresh air only if you can do so safely.
  • Do not enter a smoke-filled or contaminated area.
  • Call 911.
  • Remove contaminated outer clothing when directed.
  • Avoid exposing yourself or other people.
  • Follow decontamination instructions.
  • Call Poison Control at 1-800-222-1222 for nonemergency exposure guidance.

Breathing symptoms after smoke or chemical exposure may worsen even if the person initially feels better.

If the Person Becomes Unresponsive

  • Call 911 if no one has called.
  • Place the person on a firm, flat surface.
  • Check for normal breathing.
  • Begin CPR if they are not breathing normally.
  • Use an AED as soon as it is available.
  • Give naloxone if an opioid overdose may be involved.
  • Continue until emergency professionals take over.

Gasping is not normal breathing.

Do Not

  • Leave the person alone.
  • Force them to lie flat.
  • Tell them to breathe into a paper bag.
  • Give food or drinks.
  • Give sedating medication.
  • Use another person’s prescription medication.
  • Expose them to smoke, vapor, or strong scents.
  • Delay calling 911 because an inhaler or nebulizer is available.
  • Assume that a lack of wheezing means the person is improving.
  • Let the person drive themselves for emergency care.

After an Asthma Attack

After symptoms improve:

  • Follow the asthma action plan.
  • Contact the person’s healthcare professional as directed.
  • Replace used or empty medication.
  • Check inhaler expiration dates.
  • Clean the spacer or nebulizer according to instructions.
  • Discuss what may have triggered the attack.
  • Review when to use rescue medication.
  • Make sure medication is accessible at home, school, work, and during travel.

Using a rescue inhaler more often than usual or waking frequently with symptoms may indicate that asthma is not well controlled.

Quick Breathing-Emergency Checklist

  • Call 911 for severe or rapidly worsening symptoms.
  • Keep the person sitting upright.
  • Move away from triggers when safe.
  • Help with prescribed rescue medication.
  • Follow the asthma action plan.
  • Use epinephrine for suspected anaphylaxis.
  • Give naloxone if opioid overdose is possible.
  • Begin choking first aid if the airway is blocked.
  • Begin CPR if the person becomes unresponsive and is not breathing normally.
  • Do not leave the person alone.
  • Do not use a paper bag.
  • Do not delay emergency care.

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Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.