If someone is so short of breath that they cannot speak, call emergency services immediately. Stay with them and help them sit in the position that makes breathing easiest. Loosen tight clothing and help them use their prescribed rescue medicine, if they have one. Do not give food or drink. If they become unresponsive and are not breathing normally, start CPR and follow the emergency dispatcher's instructions.
Why is it an emergency if someone cannot speak because of breathlessness?
Speaking requires enough air to move through the lungs and voice box. When someone is struggling to breathe so much that they cannot form words or can manage only a few words at a time, they may be experiencing respiratory distress. The American Red Cross identifies this difficulty speaking as a warning sign that requires immediate emergency care.
Do not wait for the person to become unconscious or for their lips to change colour before seeking help. Even if they are awake and appear able to understand you, their breathing difficulty may be serious. Call your local emergency number and explain that the person is too breathless to speak.
What should you do immediately?
- Call emergency services.
Make the call as soon as you recognise that the person cannot speak because of breathlessness. Give the dispatcher your location, describe what you see and hear, and follow their instructions. If another person is present, ask them to make the call while you stay with the person who is struggling to breathe.
- Help them sit in a comfortable position.
Encourage the person to sit upright or adopt whichever position makes breathing easiest. Do not force them to lie flat, stand up or walk around. Loosen tight clothing around the neck and chest if this can be done easily. Speak calmly and reassure them that help is on the way.
- Help them use their prescribed emergency medicine, if appropriate.
If the person has a prescribed rescue inhaler for asthma or another emergency medicine for a known condition, help them use it according to their treatment plan and the emergency dispatcher's instructions. For an asthma attack, the British Red Cross advises helping the person sit comfortably and use their inhaler. If they cannot talk, are getting worse or their inhaler is not helping, emergency assistance is needed.
- Stay with them and monitor their breathing.
Keep watching their breathing, alertness and ability to respond while waiting for help. Do not assume they are improving simply because a wheezing sound has stopped. MedlinePlus advises monitoring the person until medical help arrives and not delaying care to see whether the breathing difficulty resolves on its own.
- Do not give food, drink or unprescribed medication.
A person struggling to breathe may have difficulty swallowing safely. Do not offer water, food or tablets by mouth while they are in distress. Do not leave them alone to look for supplies or attempt home remedies instead of obtaining emergency care.
What warning signs should you watch for?
Inability to speak because of breathlessness is already a reason to seek emergency help. Other signs that may occur during serious breathing difficulty include:
- Gasping for air or breathing unusually fast, slowly or irregularly.
- Using the muscles around the neck or ribs to help breathe.
- Making wheezing, gurgling or high-pitched breathing sounds.
- Developing pale, greyish or bluish lips or skin.
- Becoming confused, unusually sleepy, dizzy or faint.
- Experiencing chest pain or pressure.
- Developing swelling of the face, tongue or throat, particularly with breathing difficulty.
These signs do not identify one specific cause. However, they can help you explain the person's condition to the emergency dispatcher. The Mayo Clinic advises immediate emergency care for severe shortness of breath, particularly when it occurs with chest pain, fainting, blue lips or nails, or changes in alertness.
What if the person becomes unconscious?
If the person stops responding, check whether they are breathing normally. Do not spend time searching for a pulse if you are not trained to do so. If they are unresponsive and are not breathing normally, or are only gasping, call emergency services if this has not already been done, begin CPR and ask someone to bring an automated external defibrillator (AED) if one is available. Follow the emergency dispatcher's instructions and the AED's prompts.
The American Red Cross guidance on an unresponsive person recommends starting CPR immediately when a person is unresponsive and not breathing normally or is only gasping. If the person is unconscious but breathing normally, tell the dispatcher and follow their guidance on safe positioning and monitoring. If an injury to the head, neck or back is possible, avoid unnecessary movement.
Does the advice change if the person is having an asthma attack?
The first priority remains getting emergency assistance. If the person has asthma, help them use their prescribed rescue inhaler according to their asthma action plan. Do not delay calling for help while waiting to see whether the inhaler works. The same urgent response is needed if the person becomes exhausted, their breathing worsens or they cannot speak.
Breathlessness can also occur with severe allergic reactions, respiratory infections and heart or lung emergencies. The cause may not be obvious to someone providing first aid, so avoid trying to diagnose the problem before seeking assistance. Tell the dispatcher about any known medical conditions, prescribed emergency medicines and possible triggers, if that information is available.
How can you help a child who is too breathless to speak?
Take serious breathing difficulty in a child just as seriously as in an adult. A child may be unable to explain what they feel, and some signs are more visible than verbal. Watch for nostrils widening with each breath, skin pulling inward around the ribs or neck, grunting, unusual breathing sounds or difficulty crying or speaking. These signs can occur during respiratory distress in children.
Call emergency services if a child cannot speak, cry or make normal sounds because of breathing difficulty. Keep the child in a comfortable position, stay with them and follow the dispatcher's instructions. If the child has a prescribed rescue inhaler or other emergency medicine, help them use it as directed. Do not force food or drink, and do not wait for symptoms to become worse before asking for help.
What information should you give the emergency team?
Once help is on the way, gather any information you can without delaying care or leaving the person alone. Tell the dispatcher or responding medical team when the breathing difficulty began, whether it appeared suddenly, what the person was doing beforehand and whether their condition is changing.
Mention any known asthma, serious allergies or heart and lung conditions, along with prescribed emergency medicines. Report associated symptoms such as chest pain, fainting, swelling of the face or throat, or a change in alertness. If the person becomes unresponsive or their breathing changes, tell the dispatcher immediately.
The most important action is to recognise that being too breathless to speak is a medical emergency. Call for help immediately, keep the person comfortable, support the use of their prescribed emergency medicine when appropriate, and monitor their breathing until professional assistance arrives.