What is the immediate intervention for severe shortness of breath?

From the Guidelines

The immediate intervention for severe shortness of breath is to administer supplemental oxygen and inhaled short-acting bronchodilators, such as albuterol, while calling emergency services and positioning the person upright to maximize lung expansion. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of prompt treatment for asthma exacerbations 1. According to this study, emergency medical services (EMS) providers should administer supplemental oxygen and inhaled short-acting bronchodilators to all patients showing signs or symptoms of an asthma exacerbation.

Key interventions include:

• Administering supplemental oxygen to ensure adequate oxygen delivery to vital organs
• Using inhaled short-acting bronchodilators, such as albuterol, to relax airway muscles and improve airflow
• Positioning the person upright to reduce the work of breathing and allow better lung expansion
• Having a nebulizer, an inhaler plus a spacer/holding chamber, or both available for β2-agonist administration, as recommended by the Expert Panel 1

It's also crucial to note that if β2-agonist treatment is not possible, subcutaneous epinephrine or terbutaline can be administered for severe exacerbations, as suggested by the guidelines 1. Additionally, an older study from 1993 provides further guidance on immediate treatment for life-threatening features, including the use of oxygen, salbutamol via nebuliser, and prednisolone tablets or intravenous hydrocortisone 1. However, the most recent and highest quality evidence prioritizes the interventions outlined in the 2009 study 1.

From the FDA Drug Label

Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm The immediate intervention for severe shortness of breath is to administer 2.5 mg of albuterol by nebulization, as indicated by the dosage and administration guidelines 2.

• The medication should be used as medically indicated to control recurring bouts of bronchospasm.
• If a previously effective dosage regimen fails to provide the usual relief, medical advice should be sought immediately.

From the Research

Immediate Intervention for Severe Shortness of Breath

The immediate intervention for severe shortness of breath (SOB) can vary depending on the underlying cause. However, some general steps can be taken:

• Maintenance of adequate arterial oxygen saturation with supplemental oxygen 3
• Relief of airflow obstruction by administration of inhaled beta-agonists and anticholinergics 3
• Reduction of airway inflammation and prevention of future relapses by using early administration of systemic corticosteroids 3

Specific Interventions

Some specific interventions that may be considered include:

• Administration of high-flow oxygen, with full humidification of the inspired gases 3
• Use of pressurized meter dose inhalers and large-volume valved-spacers to deliver short-acting inhaled beta(2)-agonists 3
• Combination of ipratropium bromide and beta(2)-agonists as first line treatment of severe acute asthma 3

Importance of Diagnosis

It is essential to determine the underlying cause of severe SOB, as treatment may vary significantly depending on the diagnosis. For example, a patient with a foreign body obstruction in the bronchus may require bronchoscopy and removal of the object 4. In contrast, a patient with severe acute asthma may require treatment with systemic corticosteroids and inhaled beta-agonists 3.

Diagnostic Practices

Diagnostic practices for patients with shortness of breath and presumed obstructive airway disorders may vary, and previous diagnosis of obstructive airway disorders and other conditions should be assessed 5. Pulmonary function tests and other diagnostic tests may be necessary to determine the underlying cause of SOB and to guide treatment 5, 6.