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Suddenly not being able to breathe is frightening – and can be life-threatening. Acute shortness of breath (dyspnoea) is a symptom that can have very different causes: from an asthma attack to a heart attack, a pulmonary embolism or a panic attack. The key is to recognise an emergency quickly. Here you will learn when you must call 112 immediately, which causes are typical and which immediate measures really help.
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Acute shortness of breath with chest pain, blue lips or altered consciousness is a medical emergency – call 112 immediately!
Shortness of breath (medically known as dyspnoea) is the subjective feeling of not getting enough air. It can present as air hunger, as tightness in the chest, as accelerated or deepened breathing – or as the oppressive sensation of suffocating. Shortness of breath is always a symptom, never a stand-alone disease.
Acute shortness of breath comes on suddenly – within minutes to hours – and is a warning signal. It can be caused by life-threatening conditions such as a heart attack, pulmonary embolism, a severe asthma attack or anaphylaxis. Quickly identifying the cause is crucial because for some causes every minute counts.
Asthma: Sudden attacks of shortness of breath with wheezing, dry cough and tightness in the chest. Triggered by allergens, infections, exertion or cold air.
COPD exacerbation: An acute worsening of chronic obstructive pulmonary disease – increasing shortness of breath, more cough and sputum, often triggered by a respiratory infection.
Pneumonia: Shortness of breath with fever, cough, sputum and chest pain when breathing.
Pulmonary embolism: Sudden shortness of breath, breathing-related chest pain, palpitations – often after a period of immobilisation, an operation or a long journey. More on this: thrombosis and pulmonary embolism.
Pneumothorax: Sudden one-sided stabbing chest pain with shortness of breath. Often occurs in young, slim men or in people with pre-existing lung disease.
Aspiration / foreign body: Sudden shortness of breath while eating – particularly in children and older people.
Heart attack: Shortness of breath can be an important symptom – especially in women, people with diabetes and older people, in whom typical chest pain may be absent. More: coronary heart disease.
Acute left-sided heart failure / pulmonary oedema: Fluid build-up in the lungs in acute heart failure. Shortness of breath at rest, worse when lying down (orthopnoea), foamy or pink-tinged sputum, crackling sounds. An emergency.
Cardiac arrhythmias: Atrial fibrillation or ventricular tachycardia – sudden shortness of breath with palpitations, dizziness and possible altered consciousness.
Anaphylaxis (allergic shock): Acute shortness of breath with swelling, skin rash and circulatory reaction. An emergency – call 112 immediately and use an adrenaline auto-injector (e.g. EpiPen) if available.
Hyperventilation / panic attack: Rapid, shallow breathing with tingling in the hands and around the mouth, dizziness and a feeling of tightness. Common in anxiety disorders or acute psychological crises. Important: hyperventilation itself is not dangerous – but organic causes must be ruled out first.
Severe iron deficiency anaemia: If haemoglobin is very low, shortness of breath on exertion, fatigue and palpitations may occur.
Poisoning: Carbon monoxide (CO), irritant gases or drug intoxication can cause shortness of breath.
Shortness of breath in children must always be taken seriously – their airways are narrower and their reserves smaller. Warning signs are visible retractions between the ribs or at the neck while breathing, nasal flaring (movement of the nostrils when breathing), very rapid breathing (tachypnoea), a barking cough with wheezing on inhalation (suspected croup), weak feeding, apathy and pale or bluish skin.
Common causes are heart failure, COPD, pneumonia or a pulmonary embolism after immobilisation. Symptoms can be atypical – confusion, weakness or falls are sometimes the only clues. Side effects of medications (e.g. beta blockers, ACE inhibitors, nitrates) must also be considered.
If symptoms get acutely worse, use the rescue inhaler immediately (a short-acting beta-2 agonist, e.g. salbutamol). If the inhaler does not help or only briefly, the shortness of breath is increasing or speaking is difficult: call 112. A personal asthma action plan can make handling an emergency much easier.
Sit upright, do not lie down. Loosen tight clothing. Use pursed-lip breathing – breathe in through the nose, exhale slowly through slightly pursed lips. If you have known asthma or COPD, use the rescue inhaler. For anaphylaxis, use an adrenaline auto-injector if available.
Stay calm and consciously breathe slowly and deeply – the in- and out-breaths should be the same length. Breathing into a paper bag is now viewed critically because it can be dangerous if there is an undetected organic cause. If hyperventilation keeps happening, see a doctor.
Treatment depends on the cause: in an asthma attack, short-acting beta-2 agonists are used and corticosteroids if needed; in a COPD exacerbation, bronchodilators, corticosteroids and antibiotics if needed. A heart attack requires immediate hospital admission and cardiac catheterisation. Pulmonary embolism is treated with anticoagulants, pulmonary oedema with diuretics, and anaphylaxis with immediate adrenaline.
Some medications can cause or worsen shortness of breath – others are the most important emergency treatment of all. Here is an overview of common interactions:
| Medication | Effect on shortness of breath |
|---|---|
| Salbutamol (rescue inhaler) | Treats acute shortness of breath in asthma and COPD – fast-acting beta-2 agonist |
| Beta blockers | Can cause shortness of breath in people with asthma or worsen an existing asthma attack |
| ACE inhibitors | Can cause a dry, irritating cough that may be perceived as shortness of breath |
| Adrenaline auto-injector | Emergency medication for anaphylaxis – immediate effect against shortness of breath caused by allergic shock |
Digital medication plan: Record all your medications – your treating pulmonologist and cardiologist can immediately see which active substances may cause or worsen shortness of breath. → Create a medication plan
Interaction check: Find out whether the combination of beta blocker and asthma medication could be problematic. → Start the interaction check
Reminder for taking medication: Asthma inhalers, COPD medications and anticoagulants only work if taken reliably. → Set up a reminder
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