Category: Health & Safety

Responding to Serious Difficulty Breathing or an Asthma Attack

Difficulty breathing can become life-threatening quickly. A person may describe it as shortness of breath, chest tightness, air hunger, an inability to take a full breath, or feeling as though they cannot get enough air.

Asthma is one possible cause, but serious breathing problems may also result from choking, anaphylaxis, a heart attack, a blood clot, pneumonia, smoke or chemical exposure, an opioid overdose, or another medical emergency.

When someone is struggling to breathe, do not assume the problem is anxiety or wait for the person to become unable to speak. Stop the activity, help the person use prescribed emergency medication when appropriate, and call 911 for severe or rapidly worsening symptoms.

Recognize a Breathing Emergency

Call 911 or your local emergency number when the person:

• Is gasping or struggling for each breath
• Cannot speak more than a few words
• Cannot walk because of breathlessness
• Has blue, gray, or unusually pale lips, skin, or fingernails
• Has severe chest pain or pressure
• Is confused, extremely drowsy, or difficult to wake
• Has stopped breathing normally
• Has severe throat, tongue, lip, or facial swelling
• May be choking
• Has rapidly worsening wheezing or shortness of breath
• Is using the neck, chest, or abdominal muscles forcefully to breathe
• Has skin pulling inward between the ribs or at the base of the neck
• Has a prescribed rescue inhaler that is not helping
• Has no rescue medication available
• Has a peak-flow reading in the emergency zone of their action plan
• Has another life-threatening symptom

Do not wait for every warning sign to appear.

A person with severe asthma may stop wheezing because so little air is moving through the lungs. A suddenly quiet chest can be more dangerous than loud wheezing.

Helpful Resources: Browse Temperature & Basic Health Monitoring for products, equipment, services, or supplies related to this section.

Call 911 Early

When breathing difficulty is severe:

1. Call 911.
2. Put the phone on speaker.
3. State that the person is having serious difficulty breathing.
4. Describe whether asthma, choking, an allergy, chest pain, smoke, chemicals, or an overdose may be involved.
5. Follow the dispatcher’s instructions.
6. Stay with the person.

Tell the dispatcher:

• The exact location
• The person’s age
• Whether they are awake
• Whether they can speak
• Whether their color has changed
• What medication has been used
• Whether symptoms are improving or worsening

If another person is available, send them to retrieve the person’s rescue medication, spacer, asthma action plan, prescribed oxygen, naloxone, epinephrine, or other relevant emergency supplies.

Help the Person Sit Upright

Most people with breathing difficulty find it easier to breathe while sitting upright.

Help the person:

• Sit in a chair or on the floor with back support
• Lean slightly forward
• Rest their arms on their knees or a table
• Loosen tight clothing
• Remain still and calm

Do not force someone to lie flat. Lying down may make breathing more difficult.

Do not make the person walk to another room, climb stairs, or search for medication. Bring supplies to them.

If the person becomes unconscious but continues breathing normally, place them on their side when no spinal injury is suspected.

Check Whether the Person Has Asthma

Ask:

• “Do you have asthma?”
• “Where is your rescue inhaler?”
• “Do you have a spacer?”
• “Do you have an asthma action plan?”
• “Is this what your usual asthma attack feels like?”
• “Have you used any medication already?”
• “Has it helped?”

Someone with asthma may experience:

• Wheezing
• Coughing
• Chest tightness
• Shortness of breath
• Difficulty speaking
• Rapid breathing
• Trouble completing ordinary activities
• Waking at night with breathing symptoms
• A drop in peak-flow readings

A severe attack can occur without obvious wheezing.

Follow the Asthma Action Plan

A written asthma action plan explains:

• Which daily medications to take
• Which rescue medication to use
• How much to take
• When to repeat it
• How to interpret peak-flow readings
• When to call the doctor
• When to call 911

Many plans use three zones:

Green Zone

Breathing is normal, usual activities are possible, and peak flow is near the person’s best level.

Yellow Zone

Coughing, wheezing, tightness, night symptoms, reduced activity, or a lower peak-flow reading signals worsening asthma.

Red Zone

Severe shortness of breath, difficulty speaking or completing normal activities, poor response to rescue medication, or a very low peak-flow reading signals an emergency.

Follow the person’s plan. Do not create a new medication schedule during the attack.

The CDC advises people with asthma to use their written action plan, take medication exactly as prescribed, and know how to use their inhaler correctly. CDC: Asthma Emergency Preparedness

Help With the Prescribed Rescue Inhaler

A rescue inhaler contains quick-relief medication designed to open narrowed airways. Albuterol and levalbuterol are common examples, but the person may have another prescribed product.

Help the person use their own medication according to:

• Their asthma action plan
• The prescription label
• The inhaler instructions
• The 911 dispatcher’s directions

Do not:

• Give someone another person’s prescription inhaler.
• Guess the dose.
• Continue giving repeated doses outside the plan.
• Delay calling 911 when symptoms are severe.
• Assume a controller medication will provide immediate relief.
• Force medication into the mouth of an unconscious person.

Some combination inhalers may be prescribed for both maintenance and quick relief. The correct emergency medication depends on the person’s treatment plan.

Using a Metered-Dose Inhaler With a Spacer

A spacer or holding chamber can make it easier to deliver medication into the lungs.

If the person’s prescribed inhaler and spacer are designed to be used together, general steps may include:

1. Remove the inhaler cap.
2. Check the mouthpiece for debris.
3. Shake the inhaler when the instructions require it.
4. Attach it to the spacer.
5. Have the person breathe out normally.
6. Place the spacer mouthpiece between the lips and create a seal.
7. Press the inhaler once.
8. Have the person breathe in slowly and deeply.
9. Ask them to hold the breath briefly when able.
10. Have them breathe out normally.
11. Wait and repeat only as directed by the action plan or prescription.

Some spacers can be used with a face mask. Some inhalers should not be shaken, and dry-powder inhalers use a different technique.

Follow the instructions for the exact device.

If the person cannot coordinate the technique because of severe breathing difficulty, call 911 and follow dispatcher guidance.

Nebulizer Treatments

A nebulizer turns liquid medication into a mist that can be inhaled through a mask or mouthpiece.

Use it according to the person’s treatment plan and equipment instructions.

Do not:

• Delay calling 911 to assemble a nebulizer during a severe attack.
• Use medication prescribed for someone else.
• Mix solutions unless specifically instructed.
• Use an expired or contaminated solution.
• Assume the person is safe because the machine is running.
• Leave the person alone during treatment.

If symptoms remain severe, continue worsening, or fail to improve as expected, emergency care is needed.

When Rescue Medication Does Not Work

Call 911 when:

• The person does not improve after rescue medication.
• Relief lasts only a short time.
• Symptoms continue worsening.
• The person needs medication more frequently than the action plan permits.
• The inhaler is empty or unavailable.
• The person cannot use the device.
• The person is too breathless to speak.
• Lips or nails change color.
• The person becomes exhausted, confused, or less responsive.

Mayo Clinic identifies rapid worsening, failure to improve after quick-relief medication, and shortness of breath with minimal activity as emergency asthma signs. Mayo Clinic: Asthma—Symptoms and Causes

Do Not Wait for a Peak-Flow Reading

A peak-flow meter measures how quickly a person can blow air out of the lungs. Someone with asthma may have a personal-best number and action-plan zones.

Use the meter when:

• It is part of the person’s plan.
• The person can perform the test safely.
• Testing does not delay medication or emergency care.

Do not ask a person who is severely breathless, exhausted, or unable to follow instructions to repeatedly blow into a meter.

A reading in the red zone generally requires immediate action according to the person’s plan. A normal-looking reading does not override severe symptoms.

If the Person Stops Breathing Normally

If the person becomes unresponsive and is not breathing normally:

1. Place them on a firm, flat surface.
2. Call 911 if this has not already been done.
3. Begin CPR.
4. Send someone for an AED.
5. Use the AED as soon as it is available.
6. Continue until normal breathing returns or trained responders take over.

Do not attempt to give an inhaler to an unconscious person.

Consider Choking

A choking person may:

• Suddenly stop speaking
• Be unable to cough effectively
• Make little or no sound
• Clutch their throat
• Develop pale, blue, or gray skin
• Lose consciousness

If the person can cough forcefully, encourage coughing.

If they cannot speak, breathe, or cough effectively, call 911 and begin appropriate choking first aid.

An inhaler will not remove food or another object blocking the airway.

Do not perform a blind finger sweep inside the mouth.

Consider Anaphylaxis

Breathing difficulty after food, medication, an insect sting, or another allergen may be anaphylaxis.

Look for:

• Throat tightness
• Lip, tongue, or facial swelling
• Widespread hives
• Vomiting
• Dizziness or fainting
• A weak, rapid pulse
• Sudden wheezing or coughing
• Symptoms affecting several body systems

Use prescribed emergency epinephrine immediately and call 911.

An asthma inhaler and antihistamine are not substitutes for epinephrine. Anaphylaxis can cause airway swelling and shock that an inhaler cannot reverse.

Consider a Heart Attack

Shortness of breath may be a heart attack symptom, even without obvious chest pain.

Look for:

• Chest pressure, squeezing, fullness, or pain
• Pain in an arm, shoulder, back, neck, jaw, or stomach
• Cold sweat
• Nausea
• Lightheadedness
• Unusual fatigue
• A rapid or irregular heartbeat

Call 911. Do not assume that wheezing or breathlessness is asthma when symptoms feel different from the person’s usual attacks.

Consider a Blood Clot in the Lung

A pulmonary embolism occurs when a blood clot blocks blood flow in the lungs.

Possible symptoms include:

• Sudden shortness of breath
• Sharp chest pain, especially with a deep breath
• Rapid breathing
• Rapid heartbeat
• Coughing up blood
• Dizziness or fainting
• Unexplained anxiety
• One-sided leg swelling or pain

Call 911. Do not have the person walk around, massage the leg, or drive to the hospital.

Smoke, Gas, or Chemical Exposure

If breathing difficulty follows smoke, fumes, or chemical exposure:

1. Do not enter an unsafe area.
2. Move to fresh air when it can be done safely.
3. Call 911.
4. Contact Poison Control at 1-800-222-1222 when appropriate.
5. Remove contaminated clothing and rinse exposed skin as directed.
6. Monitor breathing.

Call 911 immediately if several people in the same area develop symptoms. Carbon monoxide or another environmental hazard may be present.

Do not reenter a building to retrieve belongings or pets.

Opioid Overdose

Opioids can slow or stop breathing.

Possible signs include:

• Inability to wake
• Slow, shallow, or stopped breathing
• Gasping, snoring, or gurgling sounds
• Pinpoint pupils
• Blue, gray, or pale lips or skin
• A limp body

Call 911 and give naloxone when available.

Begin CPR or rescue breathing according to your training and dispatcher instructions. Give another naloxone dose when directed.

Stay with the person even if they wake up. Naloxone may wear off before the opioid does.

Panic and Anxiety

Panic can cause rapid breathing, chest tightness, tingling, dizziness, and a feeling of suffocation. However, similar symptoms can occur during asthma, heart problems, blood clots, allergic reactions, and other emergencies.

Do not assume breathing difficulty is “just anxiety,” especially when:

• Symptoms are new
• The person has a medical condition
• There is wheezing
• The person has chest pain
• Symptoms began during physical activity
• The person faints
• Lips or nails change color
• Breathing remains difficult
• The person cannot speak normally

Help the person sit somewhere quiet and breathe at a comfortable pace while arranging appropriate help.

Do not have them breathe into a paper bag. This can reduce oxygen and may be dangerous when another medical condition is causing the symptoms.

Serious Breathing Problems in Children

A child may not be able to describe shortness of breath.

Watch for:

• Rapid breathing
• Nostrils flaring
• Skin pulling inward between the ribs
• Skin pulling inward above the collarbones
• Belly moving forcefully
• Difficulty speaking or crying
• Inability to drink or eat
• Unusual quietness
• Grunting
• Wheezing
• Head bobbing in an infant
• Pale, blue, or gray color
• Unusual sleepiness
• Limpness

Call 911 for severe symptoms, color changes, reduced responsiveness, or an inability to speak, cry, drink, or breathe normally.

Follow the child’s asthma action plan and use the child’s prescribed rescue medication.

Older Adults and Breathing Difficulty

Older adults may have asthma, chronic obstructive pulmonary disease, heart disease, pneumonia, or several conditions at the same time.

Symptoms may appear as:

• Sudden weakness
• Confusion
• Reduced activity
• Difficulty speaking
• New wheezing
• Rapid breathing
• Inability to lie flat
• Swelling in the legs
• Unusual fatigue
• Chest or upper-abdominal discomfort

A significant change from the person’s usual breathing deserves prompt medical attention.

Prescribed Oxygen

If the person uses home oxygen:

• Follow the prescribed flow rate and emergency plan.
• Check that the tubing is connected and not kinked.
• Make sure the tank or concentrator is operating.
• Keep oxygen away from flames, cigarettes, sparks, and heat.
• Call 911 for severe symptoms.

Do not increase the oxygen flow beyond the prescribed amount unless an emergency professional instructs you to do so.

Do not use someone else’s oxygen equipment.

What Not to Give

Do not give:

• Food or drinks during severe breathing difficulty
• Someone else’s prescription inhaler
• Cough syrup
• Sedatives
• Alcohol
• Unapproved herbal remedies
• Medication that could cause drowsiness
• An antihistamine instead of epinephrine during anaphylaxis

A person who is severely breathless may choke when attempting to eat, drink, or swallow pills.

After an Asthma Attack

An asthma attack deserves follow-up even when home medication works.

Contact the healthcare professional when:

• Rescue medication was needed more often than usual.
• The attack was severe.
• Symptoms returned.
• Sleep was interrupted.
• Normal activity remains difficult.
• Peak-flow readings remain below the usual level.
• The person went to urgent care or the emergency department.
• The inhaler may be empty or expired.
• The action plan is unclear.
• Inhaler technique needs review.

Frequent rescue-inhaler use may mean asthma is not adequately controlled.

Review Inhaler Technique

Incorrect inhaler use may prevent medication from reaching the lungs.

At a follow-up appointment, ask the doctor, nurse, respiratory therapist, or pharmacist to:

• Watch the person use the inhaler.
• Confirm whether it should be shaken.
• Explain the correct breathing technique.
• Show how to use the spacer.
• Review cleaning instructions.
• Check how many doses remain.
• Explain which inhaler is for rescue and which is for daily control.

Bring every inhaler, spacer, nebulizer medication, and the action plan to the appointment.

Preventing Future Asthma Attacks

Helpful steps include:

• Take controller medication as prescribed.
• Keep rescue medication accessible.
• Use a spacer when recommended.
• Replace expired or empty inhalers.
• Follow the written asthma action plan.
• Track symptoms and peak flow when instructed.
• Avoid known triggers.
• Do not smoke or vape.
• Reduce exposure to secondhand smoke.
• Follow current vaccination recommendations.
• Treat allergies and respiratory infections according to medical guidance.
• Discuss exercise-related symptoms.
• Review cleaning products and workplace exposures.
• Schedule regular asthma follow-up.

Do not stop controller medication because symptoms have improved unless the prescriber changes the plan.

Common Mistakes to Avoid

Try not to:

• Wait for the person to become unable to speak.
• Force someone with breathing difficulty to lie flat.
• Make the person walk to find medication.
• Assume wheezing must be asthma.
• Assume a quiet chest means improvement.
• Give another person’s inhaler.
• Guess the dose.
• Delay 911 while assembling a nebulizer.
• Continue repeated medication outside the action plan.
• Use an inhaler instead of epinephrine for anaphylaxis.
• Use an inhaler for a blocked airway.
• Assume serious symptoms are anxiety.
• Have someone breathe into a paper bag.
• Give food, drink, or pills during severe breathlessness.
• Increase prescribed oxygen without instructions.
• Leave the person alone.
• Drive the person when their condition is severe or worsening.

A Simple Breathing-Emergency Checklist

When someone is having serious difficulty breathing:

1. Stop the activity.
2. Call 911 for severe or rapidly worsening symptoms.
3. Help the person sit upright.
4. Loosen tight clothing.
5. Ask about asthma, allergies, choking, chest pain, chemicals, and overdose.
6. Follow the person’s asthma action plan.
7. Help with prescribed rescue medication.
8. Use epinephrine for possible anaphylaxis according to the person’s plan.
9. Give naloxone for a suspected opioid overdose when available.
10. Do not give food or drink.
11. Monitor breathing, speech, skin color, and alertness.
12. Begin CPR if the person becomes unresponsive and is not breathing normally.
13. Use an AED as soon as possible.
14. Stay until emergency responders take over.

Breathing problems can worsen faster than expected. When the person is struggling, becoming exhausted, changing color, or failing to improve with prescribed medication, call 911 and let emergency professionals determine the cause.

Suggested Guides

• First Aid Basics: What Everyone Should Know
• Responding to an Allergic Reaction or Anaphylaxis
• What to Do When Someone Is Choking
• Recognizing a Heart Attack or Stroke
• What to Do After a Poisoning or Chemical Exposure
• Calling 911 & Explaining the Emergency

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.