What should I do if I'm an adult with a tight throat and shortness of breath, possibly indicating a life-threatening condition like anaphylaxis or acute coronary syndrome, with no known medical history or with a history of asthma (Asthma) or Chronic Obstructive Pulmonary Disease (COPD)?

Immediate Emergency Assessment and Action Required

Call 911 immediately or go to the nearest emergency department now—throat tightness with shortness of breath can represent life-threatening anaphylaxis, severe asthma exacerbation, or other critical conditions that require urgent evaluation and treatment. 1, 2

Critical First Steps: Rule Out Life-Threatening Conditions

Assess for Anaphylaxis FIRST

• If you have known allergies and recent allergen exposure (food, medication, insect sting), assume anaphylaxis and inject epinephrine immediately 1
• Anaphylaxis presents with throat tightness/difficulty breathing PLUS other symptoms: hives, itching, swelling, dizziness, or cardiovascular collapse 1, 3
• Do not wait for symptoms to worsen—epinephrine works best when given early, and symptoms can rapidly progress from mild to fatal within minutes 1
• Even if uncertain whether this is anaphylaxis, guidelines recommend erring on the side of caution and using epinephrine if available, as it is safe and delays can be deadly 1
• After epinephrine injection, still call 911—you need emergency department evaluation even if symptoms improve 1

Assess for Severe Asthma Exacerbation

If you have asthma or COPD history, evaluate for these severe features that require immediate emergency care: 1, 2

• Cannot complete a full sentence in one breath 1, 2
• Heart rate >110 beats/min 1, 2
• Breathing rate >25 breaths/min 1, 2
• Silent chest (no wheezing heard), confusion, exhaustion, or bluish discoloration of lips/skin 2

If ANY of these severe features are present, this is a medical emergency requiring immediate hospital admission 1, 2

Immediate Self-Treatment While Awaiting Emergency Care

If You Have Asthma/COPD:

• Use your rescue inhaler (albuterol/salbutamol) immediately—take 2 puffs, can repeat every 10-20 minutes if needed 1
• If you have a nebulizer at home, use nebulized salbutamol 5 mg or terbutaline 10 mg 1, 2
• Take oral corticosteroids if available: prednisolone 30-60 mg 1, 2
• Sit upright, stay calm, and focus on slow breathing 1

If Suspected Anaphylaxis:

• Inject epinephrine 0.3 mg intramuscularly into outer thigh immediately 1, 3, 4
• Lie flat with legs elevated (unless breathing is worse lying down) 1
• Epinephrine works through alpha-adrenergic receptors to reverse throat swelling and through beta-adrenergic receptors to open airways 4

Why You Cannot Wait or Self-Manage at Home

Common pitfall: Many patients delay seeking emergency care for throat tightness and shortness of breath, assuming it will resolve or trying antihistamines first—this delay can be fatal 1

• Even experienced physicians cannot predict at symptom onset whether an episode will remain mild or rapidly become life-threatening 1
• Throat tightness specifically indicates upper airway involvement, which can progress to complete airway obstruction 1, 5
• Conditions like epiglottitis, retropharyngeal abscess, or foreign body aspiration can present similarly and require immediate airway management 6, 5
• Cardiac causes (acute coronary syndrome, heart failure) and pulmonary embolism can also present with dyspnea and require urgent diagnosis 3, 7

What Emergency Providers Will Do

Initial Assessment:

• Vital signs including oxygen saturation 1, 2
• Assess ability to speak in full sentences 1, 2
• Listen for wheezing, silent chest, or stridor 1, 2
• Check for hives, swelling, or other signs of anaphylaxis 1, 3

Immediate Treatment Based on Cause:

• For severe asthma: Oxygen 40-60%, nebulized bronchodilators, IV/oral corticosteroids, possible IV magnesium or aminophylline 1, 2
• For anaphylaxis: Epinephrine, IV fluids, antihistamines, corticosteroids, airway management if needed 1, 3
• For other causes: Specific treatment based on diagnosis (antibiotics for infection, anticoagulation for PE, etc.) 7

Admission Criteria:

You will be admitted to the hospital if: 1, 2

• Any life-threatening features are present 1, 2
• Severe symptoms persist after initial emergency treatment 1, 2
• Peak flow remains <33% of predicted after treatment 1, 2
• Symptoms occurred in afternoon/evening, recent hospital admission, or you express concern about your condition 1, 2

Critical Warning Signs—Call 911 Immediately If:

• Worsening difficulty breathing or throat tightness 1, 2
• Unable to speak more than a few words 1, 2
• Confusion, drowsiness, or feeling like you might pass out 2
• Lips or face turning blue 2
• Chest pain or rapid heartbeat 3, 7

Do not drive yourself—call 911 for ambulance transport with oxygen and emergency medications available en route 1