Respiratory Emergencies: What Every Family Should Know Before It Is Too Late
A breathing emergency can happen to anyone, at any age, with little warning — a severe asthma attack, a choking incident, a sudden collapse. A pulmonologist explains how to recognise the most serious respiratory emergencies, what to do in the critical first minutes, and when every second matters.
Most of the conditions discussed throughout this article series develop gradually — over weeks, months, or years — giving time for diagnosis, treatment, and adjustment. But respiratory disease can also present as a sudden emergency: a severe asthma attack that escalates within minutes, a choking incident at the dinner table, a collapsed lung that strikes without warning, a severe allergic reaction that closes the airway.
In these moments, the actions taken in the first few minutes — by family members, bystanders, or the patient themselves — often matter more than anything that happens afterward in a hospital. This article is deliberately practical. It is not a substitute for emergency medical training, and it does not replace calling for emergency help — but it provides the knowledge that allows a family member to recognise a genuine emergency, take appropriate first action, and communicate effectively with emergency services while help is on the way.
I encourage every reader to actually read through this article now — not to bookmark it for later. In a genuine emergency, there is rarely time to search for information. Knowing this content in advance, even in outline, is what allows it to be useful when it matters.
The Universal First Step: Recognising a True Emergency
Before discussing specific scenarios, it is worth establishing the general signs that indicate a respiratory emergency requiring immediate action — call for emergency help (Rescue 1122 in Punjab, or the relevant emergency number in your area) or go to the nearest emergency department immediately without waiting:
- Severe difficulty breathing — unable to speak in full sentences, gasping, or struggling visibly
- Blue or grey discolouration of the lips, tongue, or fingertips (cyanosis)
- Loss of consciousness or severe drowsiness/unresponsiveness
- Choking with inability to cough, speak, or breathe
- Chest or neck retractions (skin pulling in with each breath) — especially in children
- A known asthma or allergy patient whose rescue medication is not working
- Sudden severe chest pain with breathlessness
If any of these are present, the priority is immediate action — call for help while beginning any appropriate first aid. Do not wait to see if the situation improves on its own.
Severe Asthma Attack — What to Do
A severe asthma attack is one of the most common respiratory emergencies and, critically, one where prompt action makes a dramatic difference to outcome.
Signs of a severe attack: unable to complete sentences in one breath, breathing rate significantly increased, visible use of neck and chest muscles to breathe, lips or fingertips turning blue, and — most concerning — a "silent chest" where wheeze is no longer audible because so little air is moving. Drowsiness or confusion during an attack is a sign of life-threatening severity.
Give the blue reliever inhaler (salbutamol) — ideally through a spacer if available — 4 to 10 puffs, one puff at a time with several breaths between each. This can be repeated every 20 minutes if needed while awaiting emergency help. Do not withhold the reliever out of concern about "too much medication" — in a severe attack, the risk of under-treatment vastly exceeds any medication risk.
Help the person sit upright, leaning slightly forward, with hands resting on knees or a table. This position allows maximum use of the chest muscles for breathing. Lying flat makes breathing significantly more difficult during an asthma attack and should be avoided.
If symptoms do not improve significantly after the first round of reliever puffs, or if any severe features (silent chest, blue lips, confusion, exhaustion) are present at any point, call for emergency medical help immediately. Do not wait for the situation to become critical — severe asthma attacks can deteriorate very rapidly.
Panic worsens breathing rate and oxygen consumption. Speak calmly, encourage slow breathing if the person can manage it, and remain with them continuously. A calm, reassuring presence genuinely helps reduce the severity of the attack.
Do not give food, drink, or oral medications during a severe attack — the person may not be able to swallow safely, and oral medications take far too long to act in an emergency. Only inhaled bronchodilator medication via inhaler/spacer should be given.
The single most dangerous moment in a severe asthma attack is the "silent chest" — when the wheeze that everyone associates with asthma actually disappears, because so little air is moving through the airways that it can no longer generate a sound. Families often misinterpret this as improvement. It is the opposite — it is one of the most serious signs of all. If wheeze suddenly stops during a severe attack and the person is still struggling to breathe, this is a medical emergency requiring immediate transport to hospital.
— Dr. Nabila Zaheer, Pulmonologist
Choking — Recognising and Responding
Choking occurs when a foreign object — most commonly food — obstructs the airway. It is one of the most time-critical emergencies and one where bystander action in the first moments is often the deciding factor in outcome.
Recognising Choking
Mild airway obstruction: the person can cough forcefully, may be wheezing between coughs, and can usually speak. In this situation, encourage continued coughing — do not interfere, as the person's own cough is the most effective way to clear a partial obstruction.
Severe airway obstruction: the person cannot speak, cannot cough effectively (a weak, ineffective cough or no cough at all), cannot breathe, and may be clutching their throat, becoming blue, or showing signs of panic. This requires immediate action.
Responding to Severe Choking — Adults and Children Over One Year
Stand to the side and slightly behind the person. Support their chest with one hand and lean them forward so the object can fall out of the mouth rather than further down the airway. Give up to five sharp blows between the shoulder blades with the heel of your other hand, checking after each blow whether the obstruction has cleared.
If back blows do not clear the obstruction, stand behind the person, place a clenched fist just above their navel and below the ribcage, grasp it with your other hand, and pull sharply inward and upward in a quick thrust. Repeat up to five times, checking after each thrust. This creates a sudden increase in abdominal pressure that pushes the diaphragm upward and can expel the obstruction.
If the obstruction is not cleared, continue alternating five back blows and five abdominal thrusts. Call for emergency help if not already done — someone else should call while first aid continues, or call yourself between cycles if alone.
If the person loses consciousness, lower them carefully to the ground and begin CPR (chest compressions and rescue breaths) if trained to do so, while continuing to call for emergency help. Chest compressions in this situation may also help dislodge the obstruction in addition to their role in CPR.
Choking in Infants Under One Year
The technique differs for infants because abdominal thrusts risk injury to their internal organs. Lay the infant face-down along your forearm, supporting the head and jaw with your hand, with the head lower than the body. Give up to five firm back blows between the shoulder blades with the heel of your hand. If unsuccessful, turn the infant face-up along your other forearm, head lower than the body, and give up to five chest thrusts using two fingers in the centre of the chest (similar location to CPR compressions but sharper and more targeted). Alternate back blows and chest thrusts and call for emergency help immediately. If the infant becomes unresponsive, begin infant CPR if trained, and continue trying to call for help.
I cannot overstate how important it is for parents and caregivers to learn proper choking first aid before it is needed — formal first aid courses are available and the techniques are not difficult to learn, but they are very difficult to perform correctly for the first time under the panic of a real emergency. A few hours of training, once, could be the most important few hours you ever spend.
— Dr. Nabila Zaheer, Pulmonologist
Severe Allergic Reaction (Anaphylaxis)
Anaphylaxis is a severe, potentially life-threatening allergic reaction that can affect breathing directly — through swelling of the throat and airway, and through severe bronchospasm in the lower airways.
Recognising Anaphylaxis — Act Within Minutes
- Sudden onset after exposure to a known or new allergen — food (especially nuts, shellfish, eggs), insect sting, or medication, typically within minutes to an hour of exposure.
- Difficulty breathing, wheeze, or a feeling of throat closing/tightness — this is the life-threatening component requiring the most urgent response.
- Swelling of the face, lips, tongue, or throat — visible swelling of these areas is a critical warning sign.
- Widespread hives, itching, or flushing of the skin — often the first sign noticed, though not present in every case.
- Dizziness, fainting, or collapse — indicates a severe drop in blood pressure (anaphylactic shock).
- Nausea, vomiting, or abdominal pain — can occur alongside other symptoms in a severe reaction.
Responding to Anaphylaxis
If the person has a known severe allergy and carries an adrenaline auto-injector (such as an EpiPen), use it immediately — inject into the outer thigh through clothing if necessary, hold for the recommended duration as per the device instructions. Call for emergency help immediately — even if symptoms appear to improve after the injection, a second wave of reaction (biphasic reaction) can occur, and the person must be monitored in a medical facility. Lay the person flat with legs raised if they feel faint, unless they are having difficulty breathing — in which case allow them to sit up to ease breathing. If breathing difficulty is the predominant symptom and an asthma inhaler is available, this can be used in addition to adrenaline while awaiting help, but does not replace adrenaline as the primary treatment for anaphylaxis. A second dose of adrenaline can be given after five to fifteen minutes if there is no improvement and a second auto-injector is available.
Sudden Severe Chest Pain With Breathlessness — Suspected Pneumothorax or Pulmonary Embolism
As discussed in detail in our chest pain article, sudden severe chest pain accompanied by breathlessness — particularly one-sided pain that is sharp and worsens with breathing — can indicate a collapsed lung (pneumothorax) or a blood clot in the lung (pulmonary embolism), both of which require emergency assessment.
What to do: call for emergency medical help immediately. Help the person into the position they find most comfortable for breathing — often sitting upright or leaning toward the affected side. Do not give food or drink. Loosen any tight clothing around the chest and waist. If the person has a known lung condition and carries home oxygen, this can be used while awaiting help, but should not delay the call for emergency assistance. Stay with the person and monitor for any worsening — particularly increasing breathlessness, blue discolouration, or loss of consciousness, which would indicate a tension pneumothorax requiring the most urgent transport.
COPD Exacerbation — Severe Worsening of Breathing
For patients with known COPD, a severe exacerbation — significant worsening of breathlessness, cough, and sputum, sometimes with confusion or drowsiness — can become a respiratory emergency, particularly if oxygen levels fall critically low or if carbon dioxide retention causes drowsiness.
If a COPD patient has a written action plan from their pulmonologist, follow it — this typically includes increasing the use of reliever inhalers, starting a course of oral steroids and/or antibiotics if prescribed in advance for this purpose, and specific criteria for when to seek emergency help. Seek emergency help if: breathlessness is severe and not responding to increased inhaler use, oxygen saturation (if monitored at home) falls below 88 to 90 percent or drops significantly from the patient's usual level, the patient becomes drowsy, confused, or difficult to rouse, or there is any blue discolouration of lips or fingertips. For COPD patients on home oxygen, do not increase the oxygen flow rate beyond the prescribed level without medical guidance — in some COPD patients, excessive oxygen can paradoxically worsen carbon dioxide retention. If oxygen saturation remains low despite the prescribed flow rate, this is itself an indication for emergency assessment rather than simply increasing the oxygen further.
What to Do While Waiting for Emergency Help
In any respiratory emergency, the period between recognising the problem and emergency help arriving is critical. The following general principles apply across most scenarios:
The single most common error in respiratory emergencies is delay — waiting to see if symptoms improve before calling for help. In genuine emergencies, this delay costs time that cannot be recovered. If in doubt, call. Emergency services would always rather attend a situation that resolves on its own than arrive too late to a situation that did not.
When calling for emergency help, provide: the exact location (address, nearest landmark, floor number if applicable), the nature of the emergency (e.g. "severe asthma attack," "choking," "severe allergic reaction"), the person's age and any known medical conditions, and your contact number. Stay on the line if instructed — dispatchers can often provide guidance on first aid actions while help is en route.
For most breathing difficulties, sitting upright or leaning forward eases breathing. For someone who has fainted or feels faint without breathing difficulty, lying flat with legs raised improves blood flow to the brain. For an unresponsive person who is breathing, the recovery position (on their side) protects the airway. Choose the position based on the predominant problem — breathing difficulty takes priority over fainting in most respiratory emergencies.
If safe and quick to do so, gather the person's relevant medications (inhalers, adrenaline auto-injector, any written action plan) to give to emergency responders — this provides crucial information about the person's condition and recent treatment. Do not delay calling for help or providing first aid to search for this information, but have someone else gather it if multiple people are present.
Stay with the person continuously. Monitor for changes — improvement, deterioration, or loss of consciousness. Be ready to begin CPR if the person stops breathing or becomes unresponsive without normal breathing — this is a skill worth learning through a formal first aid course, as the techniques and ratios for adults, children, and infants differ and are best learned through practical training rather than written instructions alone.
Prevention — Reducing the Risk of Respiratory Emergencies
While this article focuses on responding to emergencies, prevention remains the most important strategy. For patients with known respiratory conditions, the following measures significantly reduce emergency risk:
- Have a written action plan — for asthma and COPD patients, a written plan from your pulmonologist specifying what to do at each stage of worsening symptoms removes guesswork during a crisis and has been shown to reduce emergency hospitalisations.
- Keep rescue medications accessible and within date — reliever inhalers, adrenaline auto-injectors, and any emergency medications should be readily accessible at home, work, and school — not locked away or expired.
- Ensure family members and caregivers know what to do — every member of a household with a person who has severe asthma, anaphylaxis risk, or advanced COPD should know the relevant emergency response, not just the patient themselves.
- Wear medical alert identification — for patients with severe allergies or significant medical conditions, a medical alert bracelet or card provides crucial information to emergency responders if the patient cannot communicate.
- Maintain good baseline control — the best way to prevent an asthma or COPD emergency is excellent day-to-day management, as discussed throughout this article series. Most emergencies occur in patients whose underlying condition was not optimally controlled.
- Learn first aid — formal courses covering CPR, choking response, and use of adrenaline auto-injectors are widely available and provide the hands-on practice that written information alone cannot.
Every emergency described in this article is one I have seen, and every one has a story attached — a family who acted quickly and a good outcome followed; a family who hesitated and the outcome was worse. The knowledge in this article is not abstract. It is the difference, in real situations, between a frightening event that resolves and one that does not. Please take the time to actually know this — not just to have read it once.
— Dr. Nabila Zaheer, Pulmonologist
Frequently Asked Questions
My child has asthma. How many puffs of their inhaler can I give during a severe attack?
During a severe asthma attack, up to 10 puffs of the reliever inhaler (salbutamol) can be given — ideally one puff at a time through a spacer, with several breaths between each puff — while awaiting or travelling to emergency care. This is significantly more than the usual one to two puffs used for mild symptoms, and this difference is intentional and safe in a genuine emergency. The risk of under-treating a severe attack is far greater than any risk from this increased dose. If 10 puffs have been given and there is no significant improvement, or if severe features (blue lips, silent chest, exhaustion, drowsiness) are present, emergency medical care is needed regardless of how many puffs have been given.
Someone is choking but can still cough and make sounds. Should I do the Heimlich manoeuvre?
No — if someone with an airway obstruction can still cough effectively, speak, or make sounds, this indicates a mild obstruction where the airway is only partially blocked. In this situation, the person's own cough is the most effective way to clear the obstruction, and back blows or abdominal thrusts are not needed and could potentially push the object further into the airway. Encourage continued coughing, stay with the person, and monitor closely. Only proceed to back blows and abdominal thrusts if the obstruction becomes severe — the person cannot cough effectively, cannot speak, or cannot breathe.
If I am not sure whether something is a real emergency, what should I do?
Call for help. Emergency medical services exist precisely for situations of uncertainty, and dispatchers are trained to help assess severity over the phone and provide guidance. The cost of an unnecessary call is minimal compared to the cost of a delayed response to a genuine emergency. Trust the instinct that something is seriously wrong — particularly with breathing difficulties, which can deteriorate very rapidly. It is always better to call and find the situation was not as serious as feared than to hesitate when it was.
Should I keep an emergency kit at home for respiratory emergencies?
For households with a member who has a known respiratory condition, yes. A basic emergency kit might include: the person's reliever inhaler and spacer, any adrenaline auto-injector if prescribed for allergy, a written action plan from their pulmonologist, a list of current medications and medical conditions, emergency contact numbers including their pulmonologist's clinic, and — if home oxygen monitoring is part of their care — a pulse oximeter. This kit should be in a known, accessible location that all family members are aware of, checked periodically for expiry dates, and brought along if the person needs to go to hospital.
After a respiratory emergency resolves, do we still need to see a doctor?
Yes — always. Even if symptoms fully resolve, any significant respiratory emergency — a severe asthma attack, an anaphylactic reaction, a choking incident, suspected pneumothorax — warrants medical follow-up. This serves several purposes: confirming the episode has fully resolved with no ongoing concerns, identifying and addressing the trigger or underlying cause to reduce future risk, reviewing and potentially adjusting medication or action plans based on what happened, and — for conditions like anaphylaxis — arranging allergy testing and prescribing or renewing emergency medication. An emergency that resolves without follow-up is a missed opportunity to prevent the next one.
Prevention Starts With Good Control. Preparation Starts With Knowledge.
If you or a family member has a respiratory condition that carries emergency risk — asthma, severe allergies, COPD — a consultation with Dr. Nabila Zaheer at PulmoCare can ensure your management is optimised, your action plan is current, and your emergency medications are appropriate. Book your appointment today.
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