What should I do if I'm experiencing shortness of breath?

What to Do If You're Experiencing Shortness of Breath

If you are experiencing shortness of breath, you need immediate medical evaluation to determine the underlying cause, as this symptom can indicate serious conditions ranging from cardiac and pulmonary disease to life-threatening emergencies like pulmonary embolism. 1, 2

Immediate Actions Based on Severity

Call 911 Immediately If You Have:

• Very severe shortness of breath with inability to speak in full sentences 3
• Gray or blue discoloration of lips or fingernails 3
• Chest pain or discomfort in the upper body (chest, arm, neck, or jaw) 4, 3
• Loss of consciousness or fainting during or after the episode 4, 3
• Inability to lie flat due to breathing difficulty 3

Contact Your Healthcare Provider Urgently If You Have:

• Shortness of breath that persists or worsens despite rest 3
• New or worsening cough with the breathlessness 3
• Fever accompanying the shortness of breath 3
• Swelling in legs or abdomen 3
• Wheezing that develops during breathing 4

Positioning While Awaiting Help

Sit upright or in a semi-recumbent position to optimize your breathing mechanics. 3 Do not lie completely flat if you have difficulty breathing, as this can worsen symptoms, particularly if heart failure is the underlying cause. 3

What NOT to Do

• Do not assume this is just anxiety or hyperventilation without medical evaluation. Serious conditions like pulmonary embolism can present with shortness of breath as the primary symptom without chest pain. 5
• Do not delay seeking care because symptoms seem to improve temporarily. 3
• Do not use high-flow oxygen without medical supervision if you have a history of COPD. 3

Context-Specific Considerations

If Shortness of Breath Occurs During Exercise:

• Stop the activity immediately 4
• If you cannot hold a conversation during exercise due to breathing difficulty, the intensity is too high 4
• Recovery should take no more than 5 minutes; if it takes longer, seek medical evaluation 4
• Faintness, nausea, or discomfort in bones and joints accompanying exercise-related breathlessness requires medical consultation before continuing exercise 4

If You Have Known Asthma:

• Use your prescribed bronchodilator (inhaler) as directed 4
• Follow your three-zone action plan: green zone (no symptoms), yellow zone (increased symptoms requiring increased medication), and red zone (severe symptoms requiring emergency care) 3
• Seek immediate help if symptoms don't improve with your usual medications 3

Why Medical Evaluation Is Critical

The clinical presentation alone is adequate to make a diagnosis in only 66% of patients with dyspnea, meaning one-third require additional testing to identify the cause. 1 The most common causes include:

• Asthma, heart failure, and myocardial ischemia 1, 2
• Chronic obstructive pulmonary disease (COPD) 1, 2
• Pneumonia 1, 2
• Pulmonary embolism 5
• Anemia 2
• Interstitial lung disease 1

In about one-third of patients, the cause is multifactorial, involving more than one underlying disease simultaneously. 1, 2

What Your Healthcare Provider Will Do

Your provider will need to perform:

• Detailed history focusing on smoking, chemical exposures, medication use, and associated symptoms 1
• Physical examination looking for jugular venous distention, decreased breath sounds, wheezing, or clubbing 1
• Initial testing including chest X-ray, electrocardiogram, spirometry, complete blood count, and basic metabolic panel 1
• Additional testing may include brain natriuretic peptide levels to exclude heart failure or D-dimer testing to rule out pulmonary emboli 1

Common Pitfall to Avoid

Never dismiss acute shortness of breath as "hysteria" or "panic" without first excluding serious underlying conditions through proper history, examination, and basic investigations. 5 Young patients can still have life-threatening conditions like pulmonary embolism, which must be ruled out before attributing symptoms to anxiety. 5

For First Aid Providers

There is insufficient evidence to recommend routine use of supplementary oxygen by first aid providers for victims complaining of shortness of breath. 4 The priority is rapid transport to definitive medical care for proper evaluation. 4