Sudden breathlessness is frightening, and the fear makes the breathing worse. If you live with COPD, moderate to severe asthma, interstitial lung disease or long COVID, you have probably had the moment where the air seems to stop arriving and your first instinct is to breathe faster and harder. That instinct is the wrong one, and almost nobody is taught what to do instead.
This page covers two separate things, in the order they matter. First, how to tell an emergency from a flare you already recognize. Second, the steps that may help you settle a flare once you are sure that is what it is. Every clinical statement below is quoted from a named source and linked at the end. None of it replaces the written plan from the doctor treating your lung condition.
Is this an emergency, or a flare you recognize?
Answer this before you try any breathing technique. MedlinePlus, the patient library run by the National Library of Medicine, is blunt about the line. Its guidance is to “Go to the emergency room or call the local emergency number (such as 911) if:”
- “Breathing difficulty comes on suddenly or seriously interferes with your breathing and even talking”
- “Someone completely stops breathing”
Read the first line twice. Breathlessness that arrives out of nowhere, or that is bad enough that you cannot finish a sentence, is a call for emergency help, not a cue to sit down and count your breaths. Do not drive yourself. The rest of this page is about the other situation: breathlessness you have felt before, that fits the pattern your clinician has already described to you.
Symptoms that mean call your doctor rather than wait it out
MedlinePlus lists what should prompt a call to your provider when it happens along with breathing difficulty:
- “Chest discomfort, pain, or pressure. These are symptoms of angina.”
- “Fever.”
- “Shortness of breath after only slight activity or while at rest.”
- “Shortness of breath that wakes you up at night or requires you to sleep propped up to breathe.”
- “Shortness of breath with simple talking.”
- “Tightness in the throat or a barking, croupy cough.”
- “You have breathed in or choked on an object (foreign object aspiration or ingestion).”
- “Wheezing.”
- “Significant worsening of baseline shortness of breath.”
That last one is the item people talk themselves out of. A slow slide in what you can do without stopping is worth a phone call even when no single day feels like an emergency.
Five steps that may help a flare you recognize
None of these is new, and none of them is a treatment for the underlying disease. They are low cost, low risk things that may help you get on top of a familiar episode, and they work better if you have practiced them beforehand.
1. Stop moving and sit down
Continuing to walk, climb or carry spends air you do not currently have. The American Lung Association’s guidance for daily activities with COPD is specific about the stairs, which is where most people run into trouble: “If you are short of breath while using the stairs, rest and do purse lipped breathing until your breathing is under control.” Stopping is not giving up. It is the step that makes the next four possible.
2. Get into a position that takes the load off your breathing
Your posture changes how much work each breath costs. The American Lung Association advises: “Position yourself upright when sitting and standing. Try to avoid bending or reaching excessively because that can cause shortness of breath and fatigue.” For the moment after exertion it says: “If you are short of breath after using the stairs, find a safe place to lean against the wall or sit in a chair. Do pursed lip breathing.”
The same page makes the point about support in a way that is easy to copy at home. On shopping: “Use a shopping cart whenever possible. A cart can help you position yourself upright which may help you breathe better, and you can use it to lean against if you need to rest.” Note the hedge in the source. It says may help, not will. At home the equivalent is a kitchen counter, a windowsill, the back of a chair, or your own forearms resting on your thighs while you sit upright.
3. Slow the breath down with pursed lip breathing
This is the one technique most worth having in your pocket. The American Lung Association describes what it does: “This exercise reduces the number of breaths you take and keeps your airways open longer.” The instruction is short enough to remember in a bad moment: “simply breathe in through your nose and breathe out at least twice as long through your mouth, with pursed lips.”
In practice that means in through the nose for a count of two, then out through lips pursed as if you were whistling or cooling soup, for a count of four. The exhale is the part that matters, and the count is a tool for making it longer, not a target to chase.
4. Try cool air on your face
A small handheld fan aimed at the face is a common piece of advice, and it is worth being honest about how strong the evidence is. A pilot study in people with fibrotic interstitial lung disease reported “no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes.” In the interviews that went with it, participants said that “using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit,” and the authors concluded there was “a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.”
So: a measured breathlessness score did not move in a small study, while the people using it reported relief. A battery fan costs very little and carries essentially no risk, which is a reasonable basis for trying one and keeping it if it helps you. It is not a reason to skip anything else on this list.
5. Use your written action plan, and your prescribed medicine as directed
An action plan is the page that tells you what your own worsening looks like and what to do at each stage, including which medicine to start and when to call. A Cochrane review of action plans with brief patient education in COPD found that “People with COPD who are given an action plan have fewer emergency department visits and hospital stays related to breathing problems over a year,” and that “Some studies showed that giving people an action plan improved their ability to recognise and self-start treatment for worsening COPD symptoms.”
The reviewers kept their hedges, and so should we. People with a plan “took more corticosteroid and antibiotic medicines for exacerbations,” and “Giving people an action plan made no difference in their chance of dying from any cause over a year, but this finding showed some variability.” Their conclusion was still clear: “We believe that people with COPD should be given an individualised action plan with a short educational component.” That review looked at COPD. If your diagnosis is asthma, interstitial lung disease or long COVID, the same principle of a written, individual plan is worth raising with your own clinician rather than assumed.
If you do not have such a plan on paper, that is the single most useful thing to ask for at your next appointment.
The part almost everyone skips: practice when you feel fine
A technique you have never rehearsed will not be available to you in the middle of an episode. The American Lung Association is explicit that both pursed lip breathing and belly breathing should be practiced “when you’re breathing OK” rather than during acute shortness of breath, and suggests practicing for “5 to 10 minutes.” For belly breathing its instruction is to “start by breathing in through your nose,” pay attention to “how your belly fills up with air,” and “Breathe out through your mouth at least two to three times as long as your inhale.”
Five minutes a day, while nothing is wrong, is what turns these into something your body reaches for automatically. This is also the difference between reading about a technique and being able to use it, and it is a large part of what supervised rehab actually buys you.
Pacing, so you reach fewer of these moments in the first place
Steps that stop an episode are worth less than habits that prevent one. The American Lung Association’s energy conservation guidance is plain: “Take breaks or rest between activities. Keep a slow and steady pace to avoid rushing.” And on timing those breaks: “It is important to rest BEFORE you become fatigued as it will take you longer to recover once you get to a point of feeling overtired.”
Resting before you need to feels wrong, because it means stopping while you still feel capable. It is also the habit that most reliably keeps a day from ending in a flare.
Where pulmonary rehab fits
Breathing techniques are one small piece of pulmonary rehabilitation. The Cochrane review of pulmonary rehabilitation in COPD concluded that “Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control,” with an improvement in breathlessness on the Chronic Respiratory Questionnaire of 0.79 units against a clinically meaningful threshold of 0.5 units, and that “Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity.”
That is a result from supervised programs, not from reading instructions. The difference is that someone watches you breathe, corrects the technique while you are doing it, adjusts the effort to what your body is actually doing that day, and checks whether the plan is working. You can read more about what actually happens in a session, and about the gap between rehab and exercising on your own. On whether doing it by video holds up, see virtual versus in person rehab, and on length, how long a program usually takes.
Who runs the session is the thing to ask about
Virtual pulmonary rehab is not one product. Programs differ in who is on the call with you, whether the session is yours alone or shared with a cohort on a fixed timetable, and whether the care is billed to your insurance or sold as a cash package or a monthly subscription. Those are the questions worth asking any provider, including us.
At Bloom Medical Group a licensed respiratory therapist runs every session, one to one, by video, and the care is billed to commercial insurance. Not a group cohort, not a prerecorded video library, not app based coaching. What insurance covers, and the self-pay option, are laid out in our pulmonary rehab coverage breakdown. There is also an honest look at when a group format suits someone better, because for some people it does.
Your condition shapes your plan
Sudden breathlessness has a different meaning and a different plan depending on what is causing it, which is why your written plan has to come from your own clinician. Our condition pages cover what rehab looks like for COPD, moderate to severe asthma, interstitial lung disease and pulmonary fibrosis and long COVID. If the panic that comes with breathlessness is the part you dread most, that is addressed directly in rehab and is covered on our breathing anxiety page. More on technique and daily habits sits under lung health education and in our resource library.
Two practical points before you call anyone. Pulmonary rehab does need a referral from the doctor treating your lung condition, and we explain what that referral has to say and how to ask for it. And most commercial plans cover pulmonary rehab, though whether a given provider bills your plan is a separate question, which is covered in does insurance cover pulmonary rehab. If weekday hospital hours are why you never started, see rehab while working full time, and if your diagnosis is asthma rather than COPD, pulmonary rehab for severe asthma.
Frequently asked questions
MedlinePlus advises going to the emergency room or calling the local emergency number such as 911 if “Breathing difficulty comes on suddenly or seriously interferes with your breathing and even talking,” or if “Someone completely stops breathing.” Breathlessness that appears out of nowhere, or that leaves you unable to finish a sentence, is an emergency call rather than a cue to try a breathing exercise. Do not drive yourself.
The American Lung Association says pursed lip breathing “reduces the number of breaths you take and keeps your airways open longer,” and describes it as a way to help control shortness of breath in people living with asthma or COPD. The instruction is to “breathe in through your nose and breathe out at least twice as long through your mouth, with pursed lips.” It works far better if you have practiced it beforehand, which the same source recommends doing when your breathing is comfortable rather than during an episode.
The evidence is limited and mixed. A small pilot study in people with fibrotic interstitial lung disease found “no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes,” while participants in interviews said that using the fan “relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit.” A battery fan is cheap and low risk, so trying one is reasonable, but it should not replace your action plan or your prescribed medicine.
The American Lung Association advises positioning yourself upright when sitting and standing, and avoiding excessive bending or reaching because that can cause shortness of breath and fatigue. After exertion it suggests finding a safe place to lean against a wall or sit in a chair and doing pursed lip breathing. Anything that lets you sit upright and rest your arms on a solid support, such as a counter, a windowsill or your own thighs, follows the same idea.
Both, but the practice has to happen when you feel fine. The American Lung Association recommends practicing pursed lip breathing and belly breathing when your breathing is comfortable, for about 5 to 10 minutes, rather than first attempting them during acute shortness of breath. Rehearsing while nothing is wrong is what makes the technique available to you when something is.
The Cochrane review of pulmonary rehabilitation in COPD concluded that “Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control,” with a breathlessness improvement on the Chronic Respiratory Questionnaire of 0.79 units against a 0.5 unit threshold for a clinically meaningful change. Those results come from supervised programs rather than from following instructions alone.
Yes. Pulmonary rehab needs a referral from the doctor treating your lung condition. You can call 1-866-972-8228 first and we will tell you what to ask for and what the referral needs to include, or you can submit the eligibility form and we will follow up.
Talk to someone about your breathing
If shortness of breath is shaping what you do in a day, the next step is to find out whether you qualify for one-on-one virtual pulmonary rehab with a licensed respiratory therapist, billed to your commercial insurance. Sessions happen from your home, scheduled around a working day.
Call 1-866-972-8228 to speak with someone about your plan and your diagnosis, or check your eligibility here: Bloom Medical Group eligibility form. You can also reach us through our contact page, or read more about the practice and our clinical team.
This article is for education only and is not medical advice. Talk with your doctor about what is right for you.
Sources
- MedlinePlus (National Library of Medicine). Breathing difficulty. https://medlineplus.gov/ency/article/003075.htm
- American Lung Association. Breathing Exercises. https://www.lung.org/lung-health-diseases/wellness/breathing-exercises
- American Lung Association. Conserving Energy and Managing Your Daily Activities. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/daily-activities
- Khor YH, Saravanan K, Holland AE, Lee JYT, Ryerson CJ, McDonald CF, Goh NSL. A mixed-methods pilot study of handheld fan for breathlessness in interstitial lung disease. Sci Rep. 2021;11:6874. https://www.nature.com/articles/s41598-021-86326-8
- Howcroft M, Walters EH, Wood-Baker R, Walters JAE. Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016;(12):CD005074. https://www.cochrane.org/evidence/CD005074
- McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;(2):CD003793. https://www.cochrane.org/evidence/CD003793
