Management of Acute Breathlessness

Initial Assessment and Oxygen Therapy

The British Thoracic Society recommends measuring oxygen saturation using pulse oximetry, which must be available in all locations where emergency oxygen is used 1, 3
The British Thoracic Society suggests checking vital signs including respiratory rate, heart rate, and blood pressure to assess severity, although this citation is from Praxis Medical Insights, a similar recommendation can be found in 2
For patients with risk factors for hypercapnic respiratory failure, the British Thoracic Society recommends considering arterial blood gas (ABG) measurement 2, 5
The British Thoracic Society identifies patients at risk of hypercapnic respiratory failure, such as those with COPD, neuromuscular disease, chest wall deformities, or morbid obesity 1, 6

For patients without risk of hypercapnic respiratory failure with SpO2 <94%, the British Thoracic Society recommends starting with nasal cannulae (1-4 L/min) or simple face mask (5-10 L/min) to achieve target saturation of 94-98% 2
For patients with risk of hypercapnic respiratory failure, the British Thoracic Society recommends targeting oxygen saturation of 88-92% and using controlled oxygen therapy via Venturi mask (24-28%) 1, 6

The BMJ recommends positioning the patient to optimize ventilation, such as sitting upright or leaning forward with arms bracing a chair or knees 7, 8
The BMJ suggests teaching controlled breathing techniques, such as pursed-lip breathing or relaxing and dropping shoulders to reduce hunched posture associated with anxiety 7, 8

For patients with end-of-life breathlessness who are distressed despite other measures, the BMJ recommends considering opioids based on patient status 7, 8

The British Thoracic Society recommends recording oxygen saturation, delivery system, and flow rate on patient monitoring charts and seeking medical advice if the patient appears to need increasing oxygen therapy, there is a rising National Early Warning Score (NEWS), or signs of respiratory deterioration are present 1, 2
The British Thoracic Society suggests reassessing frequently if breathlessness persists despite normal oxygen saturation and considering use of a hand-held fan as first-line treatment when oxygen saturation is normal 4

For critical illness, the British Thoracic Society recommends initiating treatment with reservoir mask at 15 L/min and targeting saturation range of 94-98% 1
For cardiopulmonary resuscitation, the British Thoracic Society suggests using highest feasible inspired oxygen during CPR and aiming for 94-98% once spontaneous circulation returns and SpO2 can be monitored reliably 1
For carbon monoxide poisoning, the British Thoracic Society recommends aiming for oxygen saturation of 100% using reservoir mask at 15 L/min 1

The British Thoracic Society warns against administering oxygen without monitoring saturation, targeting 100% saturation in all patients, delaying oxygen therapy in critically ill patients, and continuing oxygen therapy without reassessment when the patient has stabilized 1, 3, 6
The BMJ suggests considering non-pharmacological interventions alongside oxygen therapy to avoid failing to provide comprehensive care 7, 8