Shortness of Breath: When to Go to the ER

Few symptoms are as frightening as feeling you can't get enough air. It can hit suddenly while you're sitting on the sofa, creep up over days with a cough that won't stop, or wake you in the middle of the night. Sometimes the cause is minor. Sometimes it's a sign of something that needs treatment within hours. This guide doesn't try to diagnose you. It helps you make one decision: do I call 911 now, go to the ER, or see a doctor soon?

What counts as shortness of breath, and when is it normal?

Shortness of breath is the feeling that you aren't getting enough air, or that breathing has become hard work or uncomfortable. There is no single definition; it is something only you can feel. Getting puffed on the stairs, after exercise you aren't used to, or with a badly blocked nose is usually normal and settles with rest. What makes it worrying is change: breathlessness that is new, worse than usual, or happens with very little effort, at rest, or while talking.

If you already live with a long-term lung or heart condition, the key question is: is this clearly worse than my usual? If the answer is yes, don't wait for your next routine appointment.

When should I call 911 for shortness of breath?

Call 911 straight away, and don't drive yourself, if any of these apply:

• Severe difficulty breathing: gasping, choking, or unable to finish a sentence.
• Lips or skin turning very pale, blue or grey. On brown or black skin, this may be easier to see on the palms of the hands.
• Chest pain, pressure or heaviness, especially if it spreads to the arm, back, neck or jaw.
• Sudden confusion, extreme drowsiness, or trouble staying awake.
• Sudden breathlessness after a food, sting or new medicine, with a swelling face, lips, tongue or throat: this can be anaphylaxis.
• Choking on an object stuck in the throat, passing out, or stopping breathing.

If you have a prescribed adrenaline auto-injector and suspect a severe allergic reaction, use it, then call 911. Read more in our guide to allergic reaction and anaphylaxis signs. For chest pain specifically, see chest pain: when to go to the ER.

When should I go to the ER the same day?

These signs don't always mean calling an ambulance if you are stable and talking normally, but they do mean not waiting until tomorrow:

Sudden breathlessness with a swollen calf: possible blood clot

A pulmonary embolism is a blood clot blocking a blood vessel in the lung, and it often starts in the leg and travels up. Typical signs are breathlessness that comes on suddenly, chest pain that is worse when you breathe in, and sometimes coughing up blood. You may also notice pain, redness and swelling in one calf. The risk is higher after surgery or a hospital stay, and after long journeys by plane, bus or train; the risk of a leg clot is higher on flights lasting more than 4 hours. It can be life-threatening if not treated quickly, so if the breathlessness is severe, or you feel faint or your heart is racing, call 911.

Sharp one-sided chest pain: possible collapsed lung

A collapsed lung (pneumothorax) happens when air leaks out of the lung into the space between the lung and the chest wall, so the lung can't expand properly. It causes sudden, sharp chest or shoulder pain that is worse with a deep breath or a cough, plus breathlessness. It can follow a chest injury or happen with no obvious cause, and it is more common in tall, thin people, smokers and people with lung disease.

Also go to the ER for

• New breathlessness that comes on suddenly, even without other signs.
• Coughing up blood.
• Fever with a cough bringing up phlegm, and breathing that is getting harder, or feeling very unwell.
• An asthma attack that isn't responding properly to your reliever inhaler, or needing it far more than usual.
• A racing or pounding heart with the breathlessness.
• Breathlessness in more than one person in a room with a gas heater or charcoal, together with headache or dizziness.

Asthma has its own details about inhaler use and when it turns dangerous, so see asthma attack: when to go to the ER. If winter and a heater are part of the story, read carbon monoxide poisoning symptoms from heaters. Get everyone into fresh air first.

When is urgent care or a doctor's visit enough?

If you are breathing comfortably at rest, talking in full sentences, and none of the signs above apply, same-day urgent care or a prompt doctor's visit is usually right for:

• A cough with a cold or flu and mild breathlessness that is slowly getting worse.
• Breathlessness that gets worse with your normal activities or when you lie down.
• Breathlessness with swollen ankles.
• A cough that has lasted 3 weeks or more.
• Mild wheezing in someone without known asthma.

For seasonal respiratory viruses, see flu, RSV and COVID: when to see a doctor. Home care is usually enough only when breathlessness follows obvious exertion and settles quickly with rest.

What causes sudden shortness of breath?

Shortness of breath has many causes, from common and minor to serious. This table is a rough guide to the possibilities, not a substitute for an examination:

If you vape and have noticed a cough and breathlessness that are getting worse, read vaping lung warning signs, and tell the doctor that you vape.

Is my shortness of breath anxiety or something else?

Panic attacks are one of the most common causes of sudden breathlessness, especially in younger people. They usually come with a racing heart, fast breathing, tingling in the fingers or around the mouth, dizziness, and an intense fear that something terrible is happening. The attack peaks within minutes and then settles.

The trouble is that a heart attack, a blood clot in the lung, an asthma attack and the start of a severe allergic reaction can all feel like panic in the first few minutes. So if this is the first time it has happened, it feels different from your usual attacks, it doesn't settle, or it comes with chest pain, blue lips or fainting, don't assume it's anxiety. An examination is what tells them apart, and there is nothing embarrassing about being told it was a panic attack.

For more on telling them apart, read panic attack or heart attack?.

How do I know if my child is struggling to breathe?

Children, especially babies, can't tell you they are struggling. Look at your child's chest, tummy and face while they are calm, and check for these signs:

• Breathing much faster than normal.
• The skin between the ribs or under the ribcage sucking in with each breath (retractions).
• Grunting with each breath out.
• Nostrils flaring wide with each breath.
• Loud wheezing when breathing out, or a harsh noise when breathing in.
• Struggling to feed, eat or talk because of breathing.
• Blue or grey lips, tongue or skin, or a child who is floppy or hard to wake.

Call 911 if your child is struggling for each breath and can barely cry or speak, their lips or face turn blue, they have pauses in their breathing, they become floppy or unresponsive, they have choked on a small object, or the breathing trouble started suddenly after a sting, food or medicine. Go to the ER now if their ribs pull in with each breath, they have loud wheezing with breathing trouble, or a baby under 1 year has any trouble breathing. As health guidance puts it: if you feel as a parent that your child is seriously unwell, trust your judgement.

What should I do while waiting for help?

• Sit upright or lean slightly forward. Don't lie flat on your back.
• Use your prescribed reliever inhaler as your asthma action plan tells you.
• If you have a prescribed adrenaline auto-injector and suspect a severe allergic reaction, use it.
• Loosen tight clothing around the neck, chest and waist.
• If a gas heater or charcoal is burning, turn it off if you safely can and get into fresh air.
• Don't drive yourself to the ER. Ask someone to drive you, or call 911. Bring your medicines or a list of them.
• Don't eat or drink, and don't assume things are better just because wheezing has gone quiet.

Jordan's emergency number is 911. For more on when to call and when to make your own way in, see our guide to emergency numbers in Jordan.

Urgent care or the ER? What happens when you arrive

If your breathlessness is mild, has come on gradually and you can talk comfortably, urgent care sees walk-ins around the clock. For sudden breathlessness, or breathlessness with chest pain, a swollen leg, coughing up blood or asthma that isn't responding to your inhaler, go straight to the emergency department. If you're unsure, our guide to ER vs urgent care explains the difference.

When you arrive, the most serious cases are seen first. The doctor asks when the breathlessness started and what makes it worse, examines you, listens to your chest, and checks your breathing and pulse. Depending on what they find, they may order a chest X-ray and blood tests, both available on site. If you need a test or treatment that isn't available here, the team will tell you where to go.

Sources

• NHS — Shortness of Breath
• NHS — Pulmonary Embolism
• MedlinePlus — Breathing Difficulty
• MedlinePlus — Collapsed Lung (Pneumothorax)
• American Academy of Pediatrics (HealthyChildren.org) — Breathing Trouble