Shortness of breath

Sick or not sick? Ask the nurse for a full set of observations before you arrive.

Common ward causes: pneumonia (including aspiration), pulmonary oedema or fluid overload, PE, asthma or COPD, pleural effusion.

Act now

1
Sit the patient up. Oxygen to target: 94–98%, or 88–92% if at risk of hypercapnic failure.
2
Stop IV fluids if overloaded.

ABCDE: RR, SpO₂ and oxygen delivery, work of breathing, chest sounds, JVP, oedema, calves.
Fluid balance: how much IV fluid in the last 24 hours? Drug chart: missed inhalers, opioids or sedatives.
VTE risk: immobility, surgery, cancer, missed prophylaxis.

Blood gas if SpO₂ is below target, on oxygen, or at risk of CO₂ retention.
CXR, ECG, FBC, U&E, CRP; NT-proBNP if heart failure is possible; Wells score with D-dimer or CTPA for PE.

Pulmonary oedema: IV loop diuretic; do not routinely give nitrates or opioids.
Asthma or COPD: nebulised bronchodilators and oral steroids; controlled oxygen in COPD.
Suspected PE: interim anticoagulation if imaging will be delayed and no contraindication.
Pneumonia: CURB-65 and antibiotics per local policy.

SpO₂ below target despite oxygen, RR over 30, rising CO₂ or acidosis (consider NIV), or exhaustion: senior and critical care.

Furosemide

40 mg IV (higher if already on a loop diuretic) for pulmonary oedema.

Salbutamol

5 mg nebulised; ipratropium bromide 500 micrograms nebulised. Drive with air in COPD if CO₂ is raised.

Prednisolone

30 mg oral once daily for 5 days for a COPD exacerbation.

Check the BNF and your local formulary before prescribing.

Written to current guidance (NICE CG187, NG158, NG250) · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (5)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.