Sudden Breathlessness Crisis Sudden breathlessness can create a Sudden Breathlessness Crisis crisis (sudden breathlessness crisis). A sudden breathlessness crisis happens C Call for help. Calm the person. when breathlessness comes on quickly, Observe the person closely. Evaluate how severely, and does not go away. It O severe their has become. can be very concerning for you, your M Medication like , inhaled bronchodilator family, and others caring for you. and/or medication for may help. Dyspnea is the word used by health care providers to Fan to create air movement on the face. describe shortness of breath or breathlessness (see ATS F Open a window. Cool the room. Patient Series http://patients.thoracic.org/information- series/en/resources/ATS_Patient_Ed_Breathlessness. . Increase the amount of oxygen or O give oxygen if ordered. pdf). Not everyone with a problem experiences episodes of sudden breathlessness crises. Reassure. Help the person relax, However, people with advanced of the , R provide reassurance. , or nervous system and those at or near the end of their life are more likely to experience a sudden breathlessness crisis. T Take your time, don’t rush. How do I or someone else know if I am experiencing a sudden breathlessness crisis? or lessened breathlessness Seeing you breathless can be a concern for those • It “feels” like a crisis or seems worse than past around you. If your family or caregivers want to help episodes of breathlessness you, here are some suggestions for them. First and • It improves only with a special plan worked out by foremost, they should ask you, the person having the your health care team that helps you (See below breathlessness, to tell them what you are feeling. If you “What can be done for severe breathlessness?”) can speak, you might say feeling the “worst shortness of breath I’ve ever experienced…feeling like I am What are the causes of sudden suffocating ….it’s very hard to breathe….I am not able breathlessness crisis? to take a deep breath….I’m feeling panicky.” If you Several conditions can cause breathlessness, and are too short of breath to speak, give your family or any one or a combination of them may result caregiver (family/caregiver) a sign or signal to get help. in sudden breathlessness crisis. For example, It is helpful for you and your caregivers to agree upon breathlessness is very common in such a hand gesture to be used if you ever become too short as COPD, emphysema, , interstitial lung of breath to speak or write. disease, pulmonary and . Breathlessness crisis can happen when lung disease If you have breathing problems, there will be times is not controlled or is advanced. Heart diseases, when your breathing is worse than usual. This does particularly , can cause breathlessness not necessarily pose a crisis. For example, your crisis. that begin or spread to the lungs, or breathlessness may be similar to past episodes that those that are advanced can cause breathlessness crisis. went away on their own or with your usual treatment. Any muscle or nerve disease that affects breathing, A sudden breathlessness crisis on the other hand, for example, Lou Gehrig’s disease (ALS-amyotrophic is very severe and does not go away as usual. Other lateral sclerosis) can cause a crisis of sudden things that happen that might tell you this is a breathlessness. different kind of breathlessness are the following: • It does not improve with your routine medication or What can make sudden breathlessness worse? other things you have done in the past that relieved Sudden breathlessness may get worse in the following

Am J Respir Crit Care Med Vol. 189, P9-P10, 2014. www.thoracic.org ATS Patient Education Series © 2014 American Thoracic Society situations: breathlessness; think of the word COMFORT. • A flare-up (exacerbation) of chronic lung or heart C Call for help, use a calm voice. Know who, when, disease. and how to call for help. • Environmental factors can affect the lungs such as O Observe and ask “What is your breathlessness like”? severe or exposure to wood smoke in If they cannot speak, signs of breathing distress are fast cold weather months, may trigger a breathlessness breathing, seeing neck muscles tighten, or the stomach attack. moving in with force during breathing, and a fearful • Traveling to high altitudes. look on the face. • Developing or infection. M Medication. Know which medication is used for • Fear, anxiety, and panic. breathlessness crisis and have them ready for use. These may be an inhaled bronchodilator, morphine and/or The mind cannot be separated from the body when for anxiety. one experiences chronic or acute breathlessness. Emotions, such as a feeling of being out of control, F Fan to face. Also, try opening the window or cooling fear of dying, or increasing anxiety and panic, all can the room. If driving in a car, open the window or turn on trigger an acute breathlessness crisis. the air conditioner for air to circulate across their face. O if it was found helpful in the past. What can be done for severe breathlessness? Sudden breathlessness can be frightening for everyone R Reassure the person and stay with them if they involved. A plan or “ritual” can decrease your fears and wish. Use relaxation methods or do things that make sense of panic. The more you believe you can manage the surroundings calm. Examples are: looking outside, the feeling of overwhelming breathlessness and feel guided imagery, listening to music, meditation, prayer “in control,” the less likely there will be a sense of fear or saying a mantra (repeating a meaningful word that and panic during episodes of sudden breathlessness. It brings peace). Give a light hand or back massage. is recommended that you and your family/caregivers, T Take time, don’t rush. Stay nearby. Many times prepare in advance for this situation by developing a people do not want to talk when having severe step-by-step plan to cope with sudden breathlessness. breathlessness. The best time to learn and practice the strategies If breathlessness crises happen often, make it a routine outlined in the plan is when you are not in distress. to use the plan, so you and your family/caregiver know There are a number of things that people find helpful what to expect. You may have to change the plan when when they are experiencing crisis breathlessness. you both find something does not work. Remember, Strategies in the past that have helped decrease breathlessness is uncomfortable and frightening, breathlessness should be used first. Things you might but not necessarily harmful. You can recover from consider are the following: breathlessness. • Try approaches that have worked before, such as a With an effective plan or ritual that is regularly special inhaler or nebulizer treatment practiced when not experiencing crisis, fears may be • Change positions. Find a position that helps ease reduced and hospital emergency room visits may be your breathing. Many patients, especially those with avoided. COPD, asthma, heart failure, or cystic fibrosis find that elevating the head of the bed or using extra pillows Authors: Ann Schneidman MS, CNS, CHPN, RN; Lynn Reinke PhD, ARNP; DorAnne Donesky PhD, ANP; Virginia Carrieri-Kohlman, under the head and shoulders may help. Sitting DNSc, RN upright or in a “tripod position” (with arms straight Reviewers: Suzanne Lareau RN, MS; Mark Parshall PhD, RN in front of the person and braced on a table) may be helpful for individuals with obstructive lung diseases like COPD or asthma. Individuals with pulmonary Resources: fibrosis or , on the other hand, MedlinePlus may prefer to lie down without elevating their head. http://www.nlm.nih.gov/medlineplus/ency/ar- • Pursed lip breathing may be helpful especially for patients with COPD or asthma. ticle/003075.htm • Develop a hand sign or signal that means, “I need Patient.co.uk help!” http://www.patient.co.uk/health/controlled- Here is a simple plan of what family/caregivers can breathing-pursed-lips-breathing do to help a person that is experiencing sudden

The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing in this series is for educational purposes only and should not be used as a substitute for the medical advice one one’s personal health care provider. For further information about this series, contact J.Corn at [email protected]. www.thoracic.org