Take a Class Resources Learn First Aid Respiratory Distress (Trouble Breathing)
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  • Respiratory Distress (Trouble Breathing)

    Respiratory distress, or difficulty breathing, is evidenced by signs and symptoms such as shortness of breath, gasping for breath, hyperventilation (breathing that is faster and shallower than normal), or breathing that is uncomfortable or painful. Respiratory distress can lead to respiratory arrest (absence of breathing).

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    Causes of Respiratory Distress

    A number of different conditions can cause respiratory distress, including acute flare-ups of chronic respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD); lung and respiratory tract infections (such as pneumonia or bronchitis); severe allergic reactions (anaphylaxis); heart conditions (such as a heart attack or heart failure); trauma; poisoning; drug overdose; electrocution; and mental health conditions (such as panic disorder).

    Signs and Symptoms of Respiratory Distress

    A person who is experiencing respiratory distress is, understandably, often very frightened. The person may feel like he or she cannot get enough air and may gasp for breath. Because the person is struggling to breathe, speaking in complete sentences may be difficult. You might hear wheezing, gurgling or high-pitched noises as the person tries to breathe. You may also notice that the person’s breathing is unusually slow or fast, unusually deep or shallow, or irregular. The person’s skin may feel moist or cool, and it may be pale, ashen (gray), bluish or flushed. Lack of oxygen can make the person feel dizzy or light-headed.

    Emergency Steps

    1

    Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.

    2

    Check for signs and symptoms.

    • Shortness of breath or gasping*
    • Slow, fast, deep, shallow or irregular breathing*
    • Feels unable to get enough air*
    • Unable to talk at all or without stopping every few words*
    • Wheezing or gurgling*
    • High-pitched noises*
    • Changes in sound or weak cry*
    • Nasal flaring and/or grunting (child)*
    • Excessive use of chest and neck muscles*
    • Moist, cool, pale, ashen (gray), bluish or flushed skin*
    • Unresponsiveness*
    • Headache, dizziness, or lightheadedness*
    • Frightened appearance
    • Drowsiness or fatigue

    *Note: Signs and symptoms with a * require immediate emergency medical treatment.

    3

    Call 9-1-1 and get equipment, including an AED if available, if the person requires immediate emergency medical treatment.

    4

    Give Care.

    General Care: Respiratory Distress

    1. If unresponsive and not breathing (cardiac arrest), immediately begin CPR or compression-only CPR based on level of training and use an AED when available.
    2. Position the person as appropriate.
      1. If person is unresponsive or not fully awake and breathing, place them in the recovery position.
      2. If responsive, encourage them to sit and assume a position of comfort.
    3. Assist with or administer medication, if needed, based on level of training.
      1. If cause is known, such as asthma attack or anaphylaxis, and they use medication for emergency treatment, offer to assist or administer (if trained).
    4. Continue checking them as appropriate to determine if additional care is needed.
    5. Keep them from getting cold or overheated.
    6. Reassure them you will help and that EMS has been called (if appropriate).
    7. Watch for changes in condition, including breathing and responsiveness, and give care as appropriate and trained.

    Respiratory Distress FAQs

    How does respiratory distress affect children?

    For children, respiratory distress is a common sudden illness. Children are more susceptible than adults to respiratory distress because their airways are smaller, narrower and less rigid. In addition to the signs & symptoms seen in adults, children may have the following signs and symptoms:

    • Nasal flaring (widening of the nostrils when breathing in)
    • More pronounced use of the chest and neck muscles to breathe (muscles pull in around the collarbone and ribs)
    • Grunting

    The most common respiratory emergency in children often involves bronchospasm and can be due to a chronic condition called asthma. Two common infections associated with respiratory distress in children are croup and bronchiolitis.

    What is croup?

    Croup, also called laryngotracheobronchitis, is an upper airway infection that causes trouble breathing and a harsh, repetitive, bark-like cough. When the child breathes in, they may make a high-pitched whistling noise. Croup is most common in children younger than 5 years. Croup usually can be managed at home; however, in some cases, a child with croup can progress quickly and will require care by a healthcare professional.

    What is bronchiolitis?

    Bronchiolitis is a lower airway infection that can cause trouble breathing. Symptoms include common cold symptoms (fever, runny nose, congestion, cough), decreased appetite, irritability and vomiting. More severe symptoms include fast, labored breathing or wheezing (a high-pitched, whistling sound during exhalation) and troubling drinking or eating. Bronchiolitis is most common in infants and can also occur in young children up to about 2 years of age. Bronchiolitis can range from minor to life-threatening, depending on the symptoms.

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    Information Provided the Scientific Advisory Council (SAC)

    Behind every American Red Cross training program stands the Scientific Advisory Council - a team of experts dedicated to ensuring that what you learn is based on the latest and best emergency science. Visit redcross.org/take-a-class/scientific-advisory-council to see how we work, members, sub councils, scientific reviews, and recent research.

    Download the FREE Red Cross First Aid App

    The free First Aid mobile app by the American Red Cross puts expert advice for common emergencies in the palm of your hand—from the latest First Aid and CPR techniques to the nearest hospital location. Stay up to date on your lifesaving skills. iOS App, Google Play, or text "GETFIRST" to 90999.

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