When it comes to your breathing, waiting even an hour to “see if it clears up” can be the difference between a quick recovery and a critical failure.
Whilst a cough or a mild cold can usually be managed at home, certain respiratory symptoms indicate that your lungs are struggling to oxygenate your blood or have suffered structural damage.
If you or someone else experiences the following “red flags,” call 999 (UK) or 911 (US) immediately or head to the nearest Accident & Emergency department (or ER in the US).
A pulmonary embolism (PE) occurs when a blood clot—usually from a deep vein in the leg (DVT)—travels to the lungs and blocks an artery. This prevents blood from reaching the lung tissue to receive oxygen.
The Sensation: Sudden, sharp chest pain that feels worse when you take a deep breath (pleuritic pain). You may feel a terrifying sense of breathlessness that starts out of nowhere.
Associated Signs: Coughing up blood (hemoptysis), a rapid heart rate, and feeling lightheaded or fainting.
The Leg Connection: Look for swelling, redness, or warmth in one calf; this is often where the clot originated.
A pneumothorax occurs when air leaks into the space between your lung and chest wall. In a “tension” pneumothorax, the air builds up so much pressure that it collapses the lung and begins to push the heart and major vessels to the side.
The Sensation: Sudden, stabbing pain on one side of the chest that may radiate to the shoulder.
The Struggle: Rapidly worsening shortness of breath. Because the lung cannot expand, you may feel like you are suffocating despite trying to breathe.
Physical Sign: In extreme cases, a “tracheal shift” occurs, where the windpipe appears pushed toward one side of the neck. This is a life-threatening surgical emergency.
While many people manage asthma with daily inhalers, an acute severe attack is one where your usual “reliever” (blue) inhaler stops working because the airways have become too narrow and inflamed.
The Sensation: Tightness in the chest that feels like a band is being constricted around it.
The Red Flags: Being too breathless to speak in full sentences, or a “silent chest”—where the wheezing actually stops because there is no longer enough air moving to create the sound.
The Effort: You may see “retractions,” where the skin sucks in around the ribs or neck as the person fights to pull in air.
Pneumonia is an infection that inflames the air sacs (alveoli). If the infection is severe, the sacs fill with fluid or pus, making it difficult for oxygen to reach the bloodstream.
The Sensation: A heavy, aching chest and extreme fatigue. Breathing feels like an exhausting chore.
Associated Signs: A high fever with shivering (rigors), or conversely, an abnormally low body temperature in the elderly.
Confusion: A lack of oxygen to the brain often causes sudden confusion, disorientation, or “brain fog,” which is a sign of a medical emergency.
This is an inflammation of the “flap” (epiglottis) that covers your windpipe. If it swells, it can completely block the airway in a matter of minutes. While rarer now due to vaccinations, it remains a critical emergency.
The Sensation: A severe, rapidly worsening sore throat and difficulty swallowing.
The Warning Sound: Stridor—a high-pitched, vibrating noise heard when breathing in. This is different from a wheeze (which is usually heard when breathing out).
The Position: A person may “tripod”—leaning forward with their hands on their knees and their chin jutting out to try and keep the airway open.
Note: Do not attempt to look down their throat with a spoon or light; this can cause the airway to close completely.
If you suspect someone is in respiratory distress:
Call 999 immediately.
Keep them Upright: Unlike a fainting victim, someone struggling to breathe should not lie flat. Sit them upright in a chair or against a wall to allow the lungs maximum space to expand.
Loosen Clothing: Undo tight collars, ties, or belts.
Stay Calm: Panic increases oxygen consumption. Speak in a low, steady voice to help them focus on their breathing.
Assisted Medication: If they have a prescribed rescue inhaler (Salbutamol/Albuterol), help them use it as directed by the emergency operator.
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