Trouble Breathing: Asthma, Bronchitis and When to Come In

Call 911 now if someone cannot speak in full sentences, if their lips or face
look grey or blue, if they are using their whole body to breathe, if they are
becoming drowsy or confused, or if they have stopped being able to cough.

If you have a reliever inhaler prescribed to you, use it as you have been
shown, and call 911 if it is not working. Waiting to see whether an attack
turns around on its own is the pattern that goes badly.

Severe difficulty breathing is always an emergency, whatever the cause and
whatever the diagnosis on your chart.

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The signs that matter more than how it feels

Breathlessness is frightening, and fear makes it worse, which makes it hard to
judge from inside. These are the signs that a reaction has moved beyond
manageable:

• Not able to finish a sentence without stopping for breath
• Lips, tongue or face turning grey, blue or unusually pale
• Using the neck, shoulders and stomach to breathe — visible effort,
  shoulders rising, ribs or the base of the throat pulling in
• A chest that has gone quiet in someone who was wheezing loudly. Less
  noise is not improvement; it can mean too little air is moving.
• Drowsiness, confusion, or a sudden calm in someone who was distressed
• A reliever that is not helping, or wearing off much sooner than usual

Two of those are counter-intuitive and worth remembering: a quiet chest and a
suddenly calm patient. Both can look like the crisis passing.

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Asthma

Come in, or call 911, if:

• Your reliever is not working, or is needed far more often than usual
• You are waking at night with symptoms
• You cannot do your ordinary activities — getting dressed, walking across a
  room
• An attack came on fast and hard, whatever your usual pattern is
• You have needed emergency care for asthma before, especially if you have ever
  been admitted for it. A past severe attack is the best predictor of another
  one, and it should lower your threshold, not raise it.

A cold or a chest infection can turn a well-controlled asthma into a bad
week, and so can dust, smoke and a sudden temperature change — all of which
Arizona supplies. If your pattern has changed, that is worth a visit even
between attacks.

Bronchitis, and the honest answer about antibiotics

Bronchitis is usually a virus. It gives a cough that outstays everything else —
often three weeks, sometimes more — and it makes people miserable long after
they stopped feeling ill.

For most people, antibiotics do not help it, because they do nothing to a
virus. We will tell you that rather than hand you a prescription to end the
visit, and it is worth knowing before you come so the answer does not feel
like being dismissed. A cough that is improving slowly is doing what bronchitis
does.

But come in if:

• You are breathless at rest, or breathless doing something that did not
  make you breathless last week
• You have a fever with shaking chills, or a fever that returns after
  settling
• You are coughing up blood
• You have chest pain, particularly sharp pain when you breathe in
• You have COPD, asthma, heart failure, or a weakened immune system. The
  threshold is genuinely lower for you, and this is not a formality.
• You are getting worse rather than better after a week, or you improved and
  then declined again

That last pattern — better, then worse — is the one people talk themselves out
of, and it is one of the more useful reasons to be seen.

COPD

A flare-up that is worse than your usual bad day needs assessment, and
particularly if your breathing is worse at rest, your sputum has changed colour
or volume, you are more confused or sleepier than normal, or your ankles have
swollen.

If you use home oxygen, do not increase it on your own judgement. Call
(480) 237-4922 or 911.

Children

We are not a pediatric emergency room, and we treat children every day.

Call 911 for a child who is working hard to breathe, making a grunting noise,
going quiet and floppy, or whose lips look blue.

Come in for a child with a barking, seal-like cough and a harsh noise when
breathing in — croup, which is common, usually manageable, and occasionally
needs help quickly. It is reliably worse at night, which is why an emergency room
that is open at 2am matters for it specifically.

A child's threshold is lower than an adult's, because they tire faster and
cannot tell you what is happening.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• Your oxygen levels and breathing are checked first, because that decides
  the order of everything else.
• Treatment for the attack itself, including the severe end of it.
• X-ray on site — which is the direct answer to the question one of the
  posts this article replaces was asking. An urgent care that wants a chest film
  and does not have one has to send you elsewhere; here it happens during the
  visit, and it is how pneumonia gets separated from bronchitis.
• Laboratory work in the building.
• A critical care room here for the presentations that need one.
• Monitoring for up to 24 hours — useful in this presentation because
  breathing that improves with treatment sometimes slips back a few hours
  later, and being watched is the difference between catching that and going
  home into it.

If you need admission or hospital-level inpatient care, we stabilise you here
and arrange the transfer. We are an emergency room, not a hospital.

Bring your inhalers and a list of your medications if you can — including
what you have already taken today and when. It genuinely changes what we do
next.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• MedlinePlus (National Library of Medicine) — Asthma — https://medlineplus.gov/asthma.html
• MedlinePlus (National Library of Medicine) — Acute Bronchitis — https://medlineplus.gov/acutebronchitis.html

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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