Severe breathing difficulty
Severe breathing difficulty means struggling to get enough air. A person may be gasping, breathing very fast, unable to speak normally, using a lot of effort to breathe, or becoming blue, pale, confused, or exhausted.
This is an emergency because it can be caused by serious problems affecting the lungs, heart, airway, or blood circulation. Possible causes include severe asthma, COPD flare-up, pneumonia, allergic reaction, heart failure, blood clot in the lung, collapsed lung, choking, or another serious illness.
Emergency warning signs
Call Ambulance Nepal on 102 where available, or go to the nearest emergency department immediately, if a person has:
Gasping, choking, or severe struggle to breathe
Unable to speak full sentences because of breathlessness
Very fast breathing, noisy breathing, wheezing, or a harsh sound when breathing in
Blue, grey, or very pale lips, face, fingers, or skin
Chest pain, chest tightness, or heaviness
Sudden confusion, unusual sleepiness, collapse, or loss of consciousness
Swelling of the lips, tongue, mouth, or throat
Coughing blood
Sudden severe breathlessness with one swollen painful leg
Severe breathlessness after an injury, fall, smoke exposure, or choking episode
A child who is struggling to breathe, has ribs pulling in while breathing, grunts, cannot feed, or becomes floppy
Do not wait to see whether the person improves. Do not drive yourself if ambulance support is available.
What this page cannot tell you
This page provides general information about severe breathing difficulty. It cannot identify the cause or confirm whether the problem is asthma, pneumonia, heart failure, an allergic reaction, a blood clot, anxiety, choking, or another condition.
It cannot tell you whether oxygen, inhalers, adrenaline, antibiotics, blood tests, scans, or hospital treatment are needed. Severe breathing difficulty needs urgent assessment by trained health professionals.
Why it matters
Severe breathing difficulty can be caused by:
Severe asthma attack
COPD flare-up
Pneumonia or another serious chest infection
Heart failure or heart attack
Severe allergic reaction
Pulmonary embolism, meaning a blood clot in the lung
Collapsed lung
Choking or blockage in the airway
Severe anaemia, sepsis, poisoning, or metabolic problems
Panic or anxiety, although serious physical causes must be excluded first
Breathing difficulty matters because the brain and organs need oxygen continuously. A person can deteriorate quickly, especially if they become exhausted, confused, blue, drowsy, or unable to speak.
What you can do yourself
If someone has severe breathing difficulty:
Call for emergency help immediately.
Help them sit upright or in the position they find easiest for breathing. Do not force them to lie flat.
Loosen tight clothing around the neck or chest.
Keep the area calm and avoid crowds.
If they have a prescribed reliever inhaler or emergency plan, help them use it as directed.
If they have a known severe allergy and an adrenaline auto-injector prescribed for them, use it according to their emergency plan and seek emergency help.
Do not give food, drink, tablets, or medicines by mouth if they are very breathless, drowsy, confused, choking, or unable to swallow safely.
Do not leave them alone.
If they become unresponsive and are not breathing normally, start CPR if trained and seek emergency help immediately.
When to see a doctor
Severe breathing difficulty always needs emergency assessment.
Arrange urgent medical review for breathlessness that is less severe but:
Is new, unexplained, worsening, or keeps returning
Happens at rest or wakes you from sleep
Occurs with cough, fever, wheezing, chest pain, palpitations, ankle swelling, or weight loss
Happens after a long journey, surgery, prolonged bed rest, or leg swelling
Is limiting normal walking, work, school, or daily activity
Occurs in pregnancy, after a recent infection, or with a history of heart or lung disease
Is occurring more often than usual in someone with asthma or COPD
What a doctor may check
A doctor or emergency team may check:
Breathing rate, oxygen level, heart rate, blood pressure, temperature, and level of alertness
Ability to speak, use of chest muscles, wheezing, stridor, cough, and chest movement
Heart and lung sounds
Signs of infection, allergy, leg swelling, fluid overload, injury, or airway blockage
Medical history, allergies, regular medicines, smoking, asthma, COPD, heart disease, and recent travel
Tests may include ECG, chest X-ray, blood tests, blood gas testing, infection tests, peak flow or spirometry, ultrasound, or CT scan depending on the suspected cause.
Nepal context
In Nepal, go immediately to the nearest hospital with emergency and oxygen facilities for severe breathing difficulty. Ambulance Nepal can be contacted on 102 where available.
Useful records to keep
Keep records of:
Previous asthma, COPD, heart, allergy, or lung problems
Current inhalers, medicines, doses, and allergies
Previous severe attacks, emergency visits, hospital admissions, oxygen use, or ICU treatment
Triggers such as smoke, dust, exercise, infection, foods, medicines, or workplace exposure
Smoking or vaping history
Recent travel, surgery, leg swelling, chest infections, or COVID-19 history
Peak flow readings or oxygen readings if advised by a clinician
ECGs, chest X-rays, scan reports, and specialist letters
Important notice
This information is for general health information only. It should not be used as a substitute for a doctor's advice, examination, diagnosis, treatment, or emergency services.