What Makes an Asthma Attack Severe?

Many people have asthma. And there are many treatments to manage it. It’s important to follow the asthma action plan that you made with your doctor, avoid your triggers, take your medicine, and keep up with your doctor appointments.

Still, asthma attacks can happen, and some severe ones are an emergency.

With any asthma attack, never wait to see if it goes away on its own. It could worsen so much that you need to go to a hospital.

If you’ve used your rescue inhaler or your nebulizer and it doesn’t help, you need immediate medical care.

If you have a glucocorticoid medicine at home (such as prednisone), you can take a dose on your way to the emergency department, but you still need to make the trip.

You may hear a severe asthma attack called a “severe asthma exacerbation.” In its most severe form, you may hear it called “status asthmaticus.”

Symptoms

A severe asthma attack can cause symptoms such as:

  • Shortness of breath
  • Can’t speak in full sentences
  • Feel breathless even when you lie down
  • Chest feels tight
  • Bluish tint to your lips
  • Feel agitated, confused, or can’t concentrate
  • Hunched shoulders, strained abdominal and neck muscles
  • Feel that you need to sit or stand up to breathe more easily

Will My Wheezing or Coughing Be Worse?

Not necessarily. You might be surprised to learn that you may not have more of these than usual during a severe asthma attack. So don’t judge how bad your asthma attack is based on how much you wheeze or cough.

In fact, very severe asthma attacks may affect your airways so much that you don’t get enough air in and out of your lungs to make a wheezing sound or cough.

Causes

Doctors don’t know why some people get severe asthma attacks. It may be more likely if:

  • You don’t often see your doctor, so your asthma isn’t under good control. 
  • You come in contact with your asthma triggers or things you’re allergic to.
  • You don’t use your peak flow meter and asthma medicines as directed by your doctor in your asthma action plan.

Continued

Diagnosis

Your doctor will check on your symptoms and how well you’re breathing, any fatigue, any wheezing when you breathe in and out, and your pulse rate. You may also get tests such as a peak expiratory flow and an oxygen saturation, among others.

Treatment

With any asthma attack, you must start treatment right away, at the first sign of symptoms, either at home or in your doctor's office.

If your symptoms are severe and don’t go away after you follow your asthma action plan and use your medications as directed by your doctor, then call 911 and get emergency medical help. At the hospital, your treatment may include continuous use of an asthma nebulizer, and also epinephrine and corticosteroids to stop the attack.

The doctor at the hospital may also give you terbutaline shots and magnesium sulfate to help the muscles around your airways relax.

If medicines don’t help, you may need a mechanical ventilator in an intensive care unit to help you breathe. Your doctor will put a face mask on you, or insert a breathing tube into your nose or mouth, to do this.  These breathing aids are temporary. Your doctor will remove them once the attack ends and your lungs have recovered enough to breathe without the machine’s help.

Prevention

You may not be able to prevent all severe asthma attacks. But you can take steps to make them less likely:

  1. Take your asthma medication as often as your doctor recommends.
  2. Use a peak flow meter several times a day. These devices help to check on how well your lungs are working. Start treatment immediately according to your asthma action plan, if you notice a lower reading, even if you feel fine.
  3. Keep up with your doctor appointments to find out how well your lungs are doing and to make sure your medicines are working well for you.
WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on May 15, 2017

Sources

SOURCES:

Smolley, L. and Bruce, D. Breathe Right Now, New York, Random House, 1998.

American Family Physician, 2003.

American Academy of Family Physicians: "The Crashing Asthmatic." Expert Panel report 2: guidelines for the diagnosis and management of asthma.

National Institutes of Health, National Heart, Lung, and Blood Institute, 1997; NIH publication no. 97-4051.

Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 8: advanced challenges in resuscitation: section 3: special challenges in ECC.

The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation, 2000.

UpToDate: “Management of asthma exacerbations: Emergency department and hospital-based care.”

Medscape: “Status Asthmaticus.”

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