A draconic rune representing the body has been carefully engraved on this small pearl.

You can hurl a pearl of breath crisis as a ranged touch attack with a range increment of 10 feet. If it strikes a humanoid that fails a DC 14 Will saving throw, the pearl seems to impact and then enter the flesh of the creature, compelling it to purge itself of breath. For the next 5 rounds, the creature can continue to breathe only by taking a standard action each round to do so. This is a mind-affecting ability.
At the end of each of the target’s turns in which it chooses not to consciously take a breath, it must succeed on a DC 14 Fortitude save or begin to suffocate, falling to 0 hit points and potentially dying in later rounds (DMG 304), as long as the duration continues. If the effect ends before a suffocating creature has died, the creature is no longer considered to be suffocating.
Once activated, a pearl is expended and cannot be used again.

Prerequisites: Craft Wondrous Item, suggestion or crisis of breath (EPH 89).
Cost to Create: 1,000 gp, 80 XP, 2 days.