First aid for difficulty breathing

Sometimes, people will be able to communicate that they are feeling short of breath, but if they are not, these are the signs to look out for:

• Gasping
• Gurgling, wheezing sounds 
• Confusion, disorientation
• The need to sit up to be able to breathe 
• Coughing 
• Muffled voice
• Chest pain
• Bluish lips, fingernails, fingertips

These symptoms can be frightening and will require medical attention. Try keeping calm and call for help if you notice them. 

What causes shortness of breath will determine the action that will need to be taken. Apart from exercise, other causes for breathing difficulty are:

• Dirty, polluted air
• High altitude 
• Extreme temperatures
• Underlying health conditions such as:
  • Asthma
  • COPD
  • Heart attack or heart disease
  • Respiratory infections such as COVID-19, or pneumonia 
  • Allergic reaction
  • Anaemia
  • Lung issues such as clots or effusion 
  • Injury to the chest 
  • Lung cancer 
  • Chronic stress or anxiety

Now, if the source of the breathlessness is known, such as an asthma attack or reaction to certain foods, the prescribed medication should be given right away. As stressed above, for all unknown cases of breathlessness, call for professional help. 

Remember that the goal of first aid is to provide a calm transitional period until help arrives. Depending on the situation, here are some steps you can take: 

• If the person is unresponsive:
  • Call your doctor or an ambulance: Call for help right away, and check if the person is breathing.
  • Check the person’s airway: If they are lying down and unresponsive, try rolling them on to their back. Make them lie straight and tilt their head back—doing this opens up the airway—and check their tongue; if it's rolled back towards the throat, try to straighten the tongue so it’s not causing an obstruction. 
  • Give cardiopulmonary resuscitation (CPR): Check pulse and see if chest is moving, indicating breathing. If the person is not breathing or has a very low pulse, administer CPR, if you know how to do it. 
  • If you are able, make them lie on the side with their head tilted back. This is known as the recovery position and lets blood and vomit drain out.
• If the person is in discomfort and is responsive: 
  • Loosen any tight clothing: This may be hampering their ability to breathe deeply.
  • If the person is on medication for an underlying condition, make sure that it is given to them. 
  • Monitor the person’s pulse: This information may be important when paramedical services arrive. 
  • Cover any wounds on the chest: In the case of a chest injury, cover the wounds to prevent a collapsed lung and other severe complications. Any wounds that are producing air bubbles should be covered.

Those with heart disease and other chronic conditions often feel breathless and uncomfortable. Inform your doctor of such episodes as it may require a deeper look or a change in medication. 

Again, if the breathlessness episode persists and new symptoms develop, get help immediately. As you wait, try this deep breathing exercise: 

• Diaphragmatic breathing: This approach emphasizes long, deep breathing including slow exhalation. Sit up in a comfortable position, with your shoulders relaxed, and bend forward slightly. Put one hand on the stomach and breathe in slowly and deeply through your nose. Then, exhale slowly and for as long as you can through pursed lips. Do this for 5 minutes. 

Breathing slowly and deeply will relax you and help deliver more oxygen as well. 

Certain positions are better for relieving breathlessness.

• Sitting positions
  • Sitting forward in a chair: Sit in a comfortable chair, and lean forward a little. Your feet should be flat and a comfortable distance apart. Rest your elbows on your thighs and relax your shoulders as much as possible. Breathe slowly and deeply. 
  • Sitting forward in a chair resting the head on a table: Assume the same position as the last one, except in front of a table that is at a comfortable height. Place your arms on the table and cross them, and then rest your head on top of them. Practice breathing deeply and slowly.
• Standing position
  • Standing against the wall: Stand with your back to a high wall and lean forward slightly so your hips are touching the wall. Let your arms dangle and your shoulders relax. Open your palms and point them away from the body. Practice breathing deeply and slowly. 

These techniques can help relieve the discomfort, but remember that feeling breathless may point to something serious so make sure you inform your physician about any occurrence of this.

There are some commonly made mistakes when providing first aid as well. If a person is feeling breathless:

• Do not give them food as this can further obstruct their windpipe. 
• Do not move the person if they have a neck or chest injury, unless absolutely necessary. 
• Do not place a pillow under their head as this will make breathing harder.

Read more: First aid: types and tips

You should seek medical care if you experience breathing difficulty without adequate physical exertion. In addition to this, you should see a doctor when:

• You feel breathless suddenly and severely 
• You have chest pain along with shortness of breath
• You are frequently short of breath and it interferes with your routine
• You experience sleep interruptions due to shortness of breath
• You feel faint and dizzy 
• You feel short of breath when lying down flat on your back 
• Your breathlessness lasts for a long time after exercise 
• You have fever and chills along with shortness of breath
• Your fingertips or lips are turning blue

Shortness of breath is a typical symptom of COVID-19, the new coronavirus infection. If you develop a fever and are feeling breathless, contact a COVID helpline or your doctor and go into a separate room or part of the house to self-isolate at the earliest. Practise deep breathing if you can and try to stay relaxed.

If someone around you develops these symptoms, make sure you wear a face mask and then isolate them from other family members. Call the COVID-19 helpline and tell them about the patient's symptoms and condition. If you have a chronic condition or are older than 60, try and delegate this role to a young and healthy person in the house.

Do not give mouth to mouth to a COVID-19 patient. If you have been trained in giving CPR, give hands-only CPR. (Paramedics have breathing barriers that they can use to further reduce the risk of COVID-19 transmission during CPR.) 

If the patient is conscious while having difficulty breathing, ask them to keep walking around the room rather than lie still in bed until help arrives.