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Nasal Flaring – Causes, Symptoms & Treatment

Nasal flaring refers to the visible widening of the nostrils during breathing and is a clinical sign of increased breathing effort or respiratory distress.

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Things worth knowing about "Nasal Flaring"

Nasal flaring refers to the visible widening of the nostrils during breathing and is a clinical sign of increased breathing effort or respiratory distress.

What Is Nasal Flaring?

Nasal flaring is the visible, rhythmic widening of the nostrils (nasal alae) during inhalation. It is a clinical sign indicating increased work of breathing. In healthy adults at rest, this movement is barely noticeable. When clearly visible, it can signal respiratory distress (dyspnea) or a serious underlying condition affecting the airways or lungs.

Causes

Nasal flaring occurs when the body requires more oxygen or when the airways are partially obstructed. Common causes include:

Respiratory infections: such as bronchitis, pneumonia, or croup
Asthma: episodic narrowing of the airways causing breathing difficulty
COPD: chronic obstructive pulmonary disease causing airflow limitation
Heart failure: fluid accumulation in the lungs impairs gas exchange
Anaphylaxis: severe allergic reaction with airway compromise
Newborns and infants: nasal flaring is a key early warning sign of neonatal respiratory distress
Physical exertion: intense exercise can cause transient nasal flaring without clinical significance

Symptoms and Clinical Significance

Nasal flaring often occurs alongside other signs of respiratory distress. The following accompanying symptoms may indicate a serious condition:

Rapid breathing (tachypnea)
Retractions of the skin between the ribs or at the neck (intercostal and supraclavicular retractions)
Bluish discoloration of the lips or fingernails (cyanosis)
Restlessness, anxiety, or altered consciousness
Audible breathing sounds such as stridor or wheezing

In infants and young children, nasal flaring is a particularly important warning sign and always warrants immediate medical evaluation.

Diagnosis

Diagnosis is initially based on clinical observation. A healthcare provider assesses the work of breathing, measures blood oxygen saturation using pulse oximetry, and performs a physical examination. Depending on the suspected cause, further tests may include:

Arterial blood gas analysis to assess oxygen and carbon dioxide levels
Chest X-ray or CT scan
Pulmonary function testing (spirometry)
Laboratory tests such as complete blood count and inflammatory markers

Treatment

Treatment depends on the underlying cause of the nasal flaring:

Supplemental oxygen: immediate administration via mask or nasal cannula in cases of hypoxia
Bronchodilators: for asthma or COPD to open the airways (e.g., salbutamol)
Antibiotics: for bacterial infections such as pneumonia
Corticosteroids: to reduce airway inflammation in asthma or croup
Emergency interventions: in cases of severe respiratory failure, mechanical ventilation may be required

Nasal flaring combined with other signs of severe respiratory distress is a medical emergency and requires immediate clinical attention.

References

World Health Organization (WHO) - Integrated Management of Childhood Illness (IMCI) Guidelines, 2014.
Lissauer, T. & Carroll, W. - Illustrated Textbook of Paediatrics. 5th Edition. Elsevier, 2018.
Tintinalli, J.E. et al. - Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th Edition. McGraw-Hill, 2020.

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