The primary muscles of breathing are the diaphragm and intercostal muscles. Inhalation occurs when the diaphragm muscle contracts and the chest wall muscles expand, thereby creating a suction which pulls air into the lungs. Exhalation occurs when the chest wall retracts and the diaphragm resumes its normal domed shape. Accessory muscles in the shoulders, neck and abdomen may also be used if the primary muscles of respiration need assistance.

The tongue is a common cause of airway obstructions in adult patients. An unconscious person will begin losing muscle tone, which may allow the tongue and soft tissues to block the airway. When opening the airway, quickly inspect the patient's mouth. If you notice a foreign object in the patient's mouth, remove it. You can carefully remove a solid object with your gloved fingers. Liquids, such as blood or vomit can be removed from a non-trauma patient by rolling the patient onto their side. If you suspect a neck injury, you can still roll the patient onto their side, but you must manually stabilize their head and neck during and after the roll.

Loud or noisy breathing indicates something is wrong. Any patient who is wheezing, whistling, snoring or gurgling when they breathe has a problem. If the patient is unresponsive, manually opening the airway may be all that is needed. If that doesn't do the trick, the sound is probably coming from the lower airway and may not be fixed by a position change. The patient who is working hard to breathe also has a problem.

A responsive patient who possesses the ability to tally or make sounds indicates air is moving past the vocal cords. The ability to speak in complete sentences can help you estimate the severity of their respiratory distress. A patient who is unable to answer your questions in full sentences has a breathing problem that you should attempt to treat. To determine respiratory rate, count the number of times a patient breathes in 10 seconds, then multiply that number times 6.

Difficulty breathing, also known as dyspnea, can be brought on by many causes. Restrictive airway disease, such as asthma, or chronic obstructive pulmonary diseases such as chronic bronchitis or emphysema can be the cause. Other causes include allergic reactions and partial or complete airway obstructions. Cigarette smoke is the leading cause of respiratory diseases. According to the CDC, cigarette smoking is responsible for more than 440,000 deaths each year.