When Breathlessness Is an Emergency

Call 112 now if you see any of these

Do not wait to see if it passes, and do not drive your parent yourself if an ambulance can reach you faster.

• Struggling to breathe, gasping, or breathing very fast or very slow.
• Cannot speak in full sentences, or can only say a few words at a time.
• Blue, grey or very pale lips, tongue, face or fingertips.
• Chest pain, pressure or tightness, especially with sweating, nausea or pain spreading to the arm, jaw or back.
• Confusion, agitation, drowsiness or difficulty staying awake.
• Collapse, fainting or unresponsiveness.
• Sudden onset of severe breathlessness, particularly with chest pain, a swollen painful leg, coughing blood or recent surgery or long immobility (possible blood clot).
• Swelling of the lips, tongue or throat, wheeze and hives after a medicine, insect sting or food (severe allergic reaction).
• Choking on food or an object that does not clear.
• Inhaler or reliever that does not help, or help that lasts less than the plan says.
• Frothy, pink or blood-stained sputum.
• A very fast, very slow or irregular heartbeat with breathlessness or dizziness.
• Severely low oxygen reading such as below about 90 per cent with symptoms, bearing in mind that oximeters can mislead; see pulse oximeters: how they work and how to use one.
• Any time you feel it is serious. Trust your instinct.

For numbers and emergency services across India, see ambulance and emergency numbers in India.

Call the doctor the same day if

• Breathlessness is worse than usual but your parent can talk, is alert and is not blue.
• The reliever is needed more often than usual.
• There is fever, cough with changed sputum or ankle swelling.
• There is a new need to sleep upright, or waking at night breathless.
• Oxygen levels are lower than your parent's usual, with no distress.
• Weight gain of a kilogram or two in a few days in someone with heart failure; see daily weights in heart failure: why and how.

If in doubt, call the doctor or the emergency number and describe what you see. Follow any written action plan: see building a COPD action plan with your doctor.

Common causes of emergency breathlessness in older adults

• COPD or asthma flare-up. Wheeze, cough, tight chest, relief that is poor. See COPD at home guide and asthma in older adults.
• Pneumonia or severe chest infection. Fever, cough, confusion, fast breathing; older adults may not have a high fever. See pneumonia in older adults: prevention and recovery.
• Heart failure or fluid in the lungs. Breathlessness lying flat, waking at night gasping, swelling, frothy sputum. See heart failure at home: daily checks and warning signs.
• Heart attack. Chest pressure, sweating, nausea; sometimes only breathlessness, particularly in older women and people with diabetes. See after a heart attack: recovery at home.
• Blood clot in the lung. Sudden breathlessness, chest pain on breathing, fast pulse, leg swelling.
• Irregular heart rhythm.
• Severe anaemia or bleeding.
• Collapsed lung or fluid around the lung.
• Allergic reaction.
• Choking or aspiration of food or fluid; see swallowing problems (dysphagia) in older adults.
• Poisoning, including carbon monoxide from gas, charcoal or generators in closed rooms; headache, drowsiness, confusion and breathlessness, with several people affected. Move everyone to fresh air and call 112; see smoke and gas safety for older adults.
• Sepsis and severe infections.
• Panic and anxiety can cause breathlessness, but should be diagnosed only after serious causes are excluded.

You do not need to know the cause to call for help.

While you wait for the ambulance

Do these things while someone else makes the call, or after you call:

1. Stay calm and stay with your parent. Speak slowly and reassuringly. 2. Sit them upright, leaning slightly forward, supported by pillows or a table with a pillow to lean on, whichever is easiest. Do not lay them flat. If they are weak and cannot sit, support them in a semi-reclining position. 3. Loosen tight clothing, open windows and let in fresh air; use a fan on the face if it helps, unless oxygen is in use near it (keep electrical equipment away from oxygen). 4. Use prescribed medicines as the plan says. - Give the reliever inhaler as the doctor has prescribed, with a spacer if one is used: one puff at a time, waiting between puffs, up to the number the plan allows. Do not exceed it. - Use a nebuliser only as prescribed. - Do not give someone else's medicines. 5. Oxygen: if your parent is on prescribed home oxygen, keep it on at the prescribed flow, and check the tubing, cannula and machine. Do not turn up the flow unless the doctor or the paramedics tell you to. If there is no home oxygen, do not improvise. Keep flames and smoking away from oxygen. 6. Do not give food, drink or tablets by mouth if breathing is laboured, because of choking risk, unless advised by the call handler. 7. Chest pain: follow any instruction your parent's cardiologist gave in advance, such as a prescribed tablet, and tell the call handler. Do not give aspirin or other medicines unless advised by the call handler or a doctor, since they may not suit everyone. 8. Allergic reaction: if your parent has been prescribed an adrenaline auto-injector, use it as trained and call 112. 9. Choking: if they cannot cough, speak or breathe, give back blows and abdominal thrusts as trained, and call 112. The call handler can guide you. 10. Unresponsive and not breathing normally: call 112, start chest compressions if you are trained, and follow the call handler's instructions. Use a defibrillator if one is nearby. 11. Unlock the door, switch on lights, move furniture, and have someone wait outside to guide the ambulance. In an apartment, ask the security guard to hold the lift and show the way; see safety in gated societies and apartments. 12. Gather information: medicines (the strips or a list), medical summary, recent readings, the oxygen prescription, inhalers and spacer, and the doctor's number. See emergency contact card and medical summary and emergency bag for a hospital visit. 13. Keep the phone line open if the call handler asks you to stay on.

What to tell the call handler and paramedics

• Name, age and address, with a landmark and the entrance.
• What is happening: "my father is struggling to breathe and has blue lips."
• When it started, and whether it was sudden.
• Known conditions: COPD, asthma, heart disease, diabetes, kidney disease, dementia, cancer.
• Medicines, including inhalers, blood thinners and oxygen, and what you have given in the last hours.
• Allergies.
• Recent illness, surgery, travel or immobility.
• Readings, such as oxygen level, pulse, temperature and blood pressure, if you have them and can take them without delay.
• Oxygen prescription, flow and target range; see oxygen flow rates and prescriptions: what families should know.
• Wishes: if there are documented care preferences or a plan for advanced illness, mention them and show the documents; see palliative care at home: what it is and how to arrange it.

What not to do

• Do not wait for the oximeter to confirm what you can see.
• Do not rely on the oximeter to rule out an emergency; a normal reading can be wrong.
• Do not turn up oxygen beyond the prescription, or start oxygen from an unknown source without advice.
• Do not give extra doses of reliever beyond the plan.
• Do not give steam, home remedies or herbal drops; steam can scald and does not treat an emergency; see steam inhalation: benefits, burns and safer habits.
• Do not lay your parent flat.
• Do not smoke or use flames near oxygen.
• Do not drive a person who may collapse if an ambulance is available.

Planning ahead

• Keep 112, the doctor's number, the hospital and the oxygen supplier on a card by the phone.
• Have a written action plan for lung and heart conditions.
• Know the nearest hospital with emergency and chest or cardiac care, and how long it takes to reach in traffic.
• Have an emergency bag ready; see emergency bag for a hospital visit.
• Keep inhalers, spacers, oximeter and backup oxygen accessible and in order; see oxygen at home and power cuts: a backup plan.
• Teach household members and helpers the red flags and to call 112.

After an emergency

Afterwards, review what happened with the doctor: the cause, treatment changes, follow-up tests, the action plan and equipment. See monitoring a parent after hospital discharge.

When to ask a professional

Ask your parent's doctor now, in a calm moment, to write down what counts as an emergency for them, what to do first and whom to call. Ask a nurse or physiotherapist to teach breathing positions. Ask the pharmacist to check inhaler technique. Ask the supplier about backup oxygen. And when in doubt in the moment, call 112.