Acute Shortness of Breath: Know the Dangerous Causes and When to Go to the Emergency Room!

by: dr. Anggie Indari, Sp.P

Shortness of breath is one of the most common complaints that brings patients to the emergency room (ER). This condition can be related to various illnesses, including heart and lung disorders, infections, and other emergencies.
Some cases of shortness of breath can be caused by a severe asthma attack, but acute shortness of breath can also be a sign of:

• Pulmonary edema due to heart failure
• Severe pneumonia
• Pulmonary embolism
• Pneumothorax (collapsed or collapsed lung)
• Severe allergic reactions, and others

Some of these conditions can be life-threatening if not treated promptly.

This article helps patients and families understand: 

• What is Acute Shortness of Breath: Severe Asthma, Pulmonary Edema, or Other Causes?
• Symptoms to Watch Out For,
• How the Assessment is Performed in the Emergency Department at Premier Jatinegara Hospital, and
• An Overview of Available Treatments.

Acute Shortness of Breath: Severe Asthma, Pulmonary Edema, or Other Causes?

Sesak napas (dispnea) adalah kondisi ketika seseorang merasa sulit bernapas atau merasa napasnya tidak cukup, baik saat istirahat maupun saat beraktivitas. Sesak napas disebut akut apabila keluhan muncul secara mendadak atau dalam hitungan menit hingga jam. 

The causes of acute shortness of breath are very diverse, including:

Respiratory System (respiratory tract including lungs)

• Severe asthma (acute asthma attack).
• Chronic Obstructive Pulmonary Disease (COPD) exacerbation.
• Pneumonia (lung infection).
• Pulmonary edema (fluid buildup in the lungs, often due to heart failure).
• Pneumothorax (collapsed lung).
• Pulmonary embolism (blockage of a blood vessel in the lung).

Cardiovascular System (heart and blood vessel circulation)

• Acute heart failure.
• Acute coronary syndrome (heart attack).
• Certain heart rhythm disorders.

Other Causes 

• Severe allergic reaction or anaphylaxis.
• Septic shock due to severe infection.
• Anxiety disorders (panic attacks) – often accompany other conditions but still require exclusion of a medical cause.

Considering that the causes of shortness of breath are very diverse and some are potentially life-threatening, acute shortness of breath should not be taken lightly, especially if it appears suddenly and feels increasingly severe.

Common Symptoms or Complaints

Selain sensasi “napas terasa pendek”, pasien dengan sesak napas akut dapat mengalami: 

• Rapid and labored breathing.
• Difficulty speaking (only able to say a few words).
• Visible use of accessory muscles (shoulders and chest rise strongly when inhaling).
• Bluish lips or fingertips (cyanosis) in severe cases.
• Chest tightness, a feeling of heaviness or pressure.
• Coughing (sometimes accompanied by phlegm, frothy phlegm, or blood).
• Wheezing (more typical of asthma and COPD).
• Fine crackles in the lungs (more typical of pulmonary edema or pneumonia, audible to a doctor with a stethoscope).

Gejala penyerta yang perlu diwaspadai: 

• Chest pain (think heart attack, pulmonary embolism, pneumothorax).
• High fever, chills (pneumonia or severe infection).
• Severe weakness, decreased consciousness, dizziness, feeling like you might faint.

In children and the elderly, symptoms often cannot be clearly communicated. Therefore, families and caregivers need to be alert to signs such as rapid breathing, chest indrawing, restlessness, or a general feeling of weakness.

Risk Factors: Who Should Be More Careful?

Acute shortness of breath can happen to anyone, but it occurs more frequently and is at greater risk of being more severe in the following groups:

• People with asthma or COPD (long-term smokers).
• Patients with heart failure or a history of heart attack.
• Patients with other chronic lung diseases.
• Patients with lung infections (pneumonia, COVID-19, tuberculosis).
• Patients with malignancies (cancer) that can cause airway obstruction, pleural effusion, or embolism.
• History of thrombosis or pulmonary embolism.
• Patients with a history of severe allergies or anaphylaxis.

However, individuals without a prior medical history can also experience acute shortness of breath, for example due to spontaneous pneumothorax or sudden pulmonary embolism. Therefore, acute shortness of breath still requires serious medical evaluation.

Assessment and Management of Acute Shortness of Breath in the Emergency Room of Premier Jatinegara Hospital.

In the Emergency Room of Premier Jatinegara Hospital, patients with acute shortness of breath will be assessed using systematic steps because this is a sign of a medical emergency.

1. Initial assessment (triage and stabilization)

Measurement of vital signs: blood pressure, pulse, respiratory rate, oxygen saturation.

• Assessment of consciousness (whether the patient can communicate well).
• Administer oxygen as indicated.

Rapid assessment for:

• adrenal breath sounds (wheezing, rhonchi),
• signs of severe allergy (swollen lips/face, rash),
• signs of shock (cold, pale skin, rapid pulse, low blood pressure).

The main priority is to maintain an open airway and ensure the patient receives adequate oxygenation.

2. Further examination

Depending on the suspected cause, the doctor may perform:

• Examination of the heart, lungs, and other organs.
• Chest X-ray, to assess lung function (pneumonia, pulmonary edema, pneumothorax, cardiac enlargement).
• Electrocardiogram (ECG), to assess whether shortness of breath is related to a heart attack or a heart rhythm disorder.
• Blood tests, such as blood gas analysis, kidney function, electrolytes, infection markers, and markers of heart disease.
• Lung or heart ultrasound (USG). In many emergency care centers, a bedside ultrasound helps distinguish the cause of shortness of breath, whether it is predominantly due to a heart problem (e.g., pulmonary edema), a lung problem (e.g., pneumonia, pneumothorax), or another cause.

In certain cases, the following may be performed:

• Chest CT scan (e.g., if a pulmonary embolism or other abnormality is suspected).
• From this combination of clinical data and supporting examinations, the doctor will determine the cause of acute shortness of breath and develop a treatment plan.

Therapy and Treatment Options

Treatment for acute shortness of breath is always tailored to the cause, but the basic principles include:

1. Stabilizing the airway and oxygenation

• Oxygen administration via nasal cannula, mask, or high-flow nasal cannula is adjusted depending on the severity of the patient's condition.
• Non-invasive ventilation (CPAP/BiPAP) is used in certain cases, such as pulmonary edema or COPD/asthma exacerbations.
• If the condition is very severe and the patient is unable to breathe effectively, intubation and mechanical ventilation may be considered.

2. Specific therapy according to the cause

• Severe asthma/COPD exacerbation
• Nebulized bronchodilators (salbutamol, ipratropium according to protocol),
• Corticosteroids if needed,
• Oxygenation.
  • Cardiogenic pulmonary edema/acute heart failure: Diuretics, certain vasodilators as assessed by the physician,
  • Oxygenation
  • Further cardiac evaluation.
• Pneumonia/severe infection: Antibiotics, fluids, and supportive therapy.
• Pulmonary embolism: Anticoagulants with monitoring for signs of bleeding.
• Tension/severe pneumothorax: Emergency measures to remove air from the pleural cavity (needle decompression/chest tube placement).
• Anaphylaxis: Administration of adrenaline, fluids, antihistamines, steroids, and close monitoring.

Not all patients require surgery, but in some cases, certain procedures can be life-saving, such as inserting a chest tube for a pneumothorax.

When Should You Go to the Doctor or Emergency Room Immediately?

Go to the emergency room immediately if you or your family experience:

• Sudden or rapidly worsening shortness of breath.
• Difficulty speaking due to tightness, only able to say a few words.
• Rapid breathing, chest tightness or pain.
• Bluish lips or fingertips.
• Accompanied by chest pain, cold sweats, severe dizziness, or near-fainting.
• Accompanied by a high fever and a worsening cough.
• A history of asthma or lung disease that usually improves with medication, but this time does not improve with regular medication.

Do not wait until shortness of breath worsens to go to the emergency room, especially for young children, the elderly, and patients with pre-existing heart or lung disease.

FAQ

1. Does acute shortness of breath, for example due to severe asthma, pulmonary edema, or other causes, always require invasive intervention or surgery?

Not always. Many patients with shortness of breath can improve with medication, oxygen, and monitoring without the need for surgery or invasive intervention. Procedures such as chest tube placement or intubation are only performed if:
a. The patient's condition is life-threatening,
b. These interventions are considered the safest and most effective way to save life and vital organ function.

2. When should I see a doctor for complaints related to acute shortness of breath, for example due to severe asthma, pulmonary edema, or other causes?

• Go to the emergency room immediately if shortness of breath occurs suddenly, worsens, does not improve with regular medication, or is accompanied by warning signs such as chest pain, high fever, bluish lips, weakness, or decreased consciousness.
• For patients with asthma, COPD, or heart failure, regular check-ups are crucial to prevent severe relapses. If attacks become more frequent, discuss therapy with your doctor immediately.

If you or your family experience complaints related to acute shortness of breath: severe asthma, pulmonary edema, or other causes, immediately come to the Emergency Room at Premier Jatinegara Hospital or contact the nearest emergency service for rapid evaluation and treatment.
 

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