Severe Asthma Attacks

An acute, severe asthma attack that doesn't respond to usual use of inhaled bronchodilators and is associated with symptoms of potential respiratory failure is called status asthmaticus. This is life-threatening and requires immediate medical attention. It is important to be aware of these severe asthma attacks and prevent them with early intervention.

What Are The Symptoms of a Severe Asthma Attack?

The symptoms of a severe asthma attack may include:

  • Persistent shortness of breath
  • The inability to speak in full sentences
  • Breathlessness even while lying down
  • Chest that feels closed
  • Bluish tint to your lips
  • Agitation, confusion, or an inability to concentrate
  • Hunched shoulders and strained abdominal and neck muscles
  • A need to sit or stand up to breathe more easily

These are signs of an impending respiratory system failure and require immediate medical attention.

You may not have more wheezing and coughing with a severe asthma attack. In fact, the presence of wheezing or coughing is not a reliable standard for judging the severity of an asthma attack. Very severe asthma attacks may affect airways so much that the lack of air in and out of your lungs does not cause a wheezing sound or coughing.

Are There Warning Signs of a Severe Asthma Attack?

A severe asthma attack can sometimes occur with few warning signs. It can happen quickly and progress rapidly to severe breathing difficulties and a lack of oxygen.

Does Wheezing Indicate a Severe Asthma Attack?

Wheezing does not necessarily indicate asthma. Wheezing can also be a sign of other health conditions, such as respiratory infection, heart failure, and other serious problems.


What Causes a Severe Asthma Attack?

Whereas the causes of an acute, severe asthma attack are unknown, those people who have them may have a history of infrequent health care, which may result in poor treatment of asthma.

Some research shows that people who are at risk for a severe asthma attack have poor control of allergens or asthma triggers in the home and/or workplace. These people may also infrequently use their peak flow meter and inhaled corticosteroids. Inhaled steroids are potent anti-inflammatory drugs that are highly effective in reducing inflammation associated with asthma.

To prevent a severe asthma attack, it is important to monitor your lung function using a peak flow meter regularly and take your asthma medication as recommended by your health care provider.

How Is a Severe Asthma Attack Diagnosed?

To diagnose a severe asthma attack as actual status asthmaticus, your doctor will notice physical findings such as your consciousness, fatigue, and the use of accessory muscles of breathing. Your doctor will notice your respiration rate, wheezing during both inhalation and exhalation, and your pulse rate. Some other tests may include peak expiratory flow and oxygen saturation, among others. Other physical symptoms will be noticed with the chest, mouth, pharynx, and upper airway.

How Is a Severe Asthma Attack Treated?

A severe asthma attack may not respond quickly to routine treatment with asthma inhalers. Continuous use of an asthma nebulizer and injections of drugs such as epinephrine and corticosteroids for asthma are often necessary to stop the asthma attack. Other therapies may include terbutaline injections, magnesium sulfate (induces smooth muscle relaxation of the airways).

During a severe asthma attack that does not respond to asthma drugs, a mechanical ventilator may be needed to assist the lungs and respiratory muscles. A facemask is applied or a breathing tube is inserted in the nose or mouth for this asthma treatment. These breathing aids are temporary and are removed once the attack has subsided and the lungs have recovered sufficiently to resume the work of breathing on their own. A short hospital stay in an intensive care unit may be necessary with a severe asthma attack.

To avoid hospitalization with a severe asthma attack, it is imperative to begin immediate early treatment at the first sign of symptoms either at home or in your doctor's office. If you have asthma, it's also important to see your doctor frequently to monitor your lung function and to assess your asthma medications. Also, using your peak flow meter several times daily can help you monitor your breathing, so you can start treatment immediately if you notice a lower reading, even if you feel fine.


How Does Status Asthmaticus Differ From an Acute Asthma Attack?

An acute, or sudden, asthma attack is usually caused by an exposure to allergens or an upper respiratory tract infection. The severity of the asthma attack depends on how well your underlying asthma is controlled (reflecting how well the airway inflammation is being controlled). An acute asthma attack is potentially life-threatening because it may continue despite the use of your usual quick-relief medications (inhaled bronchodilators). When the acute asthma attack is unresponsive to treatment with an asthma inhaler (albuterol), this may then be status asthmaticus, where you'd need immediate medical attention and treatment.

Asthma attacks often do not stop on their own without asthma treatment. If you ignore the early warning signs of an asthma attack, you put yourself at risk of developing status asthmaticus, which may require hospitalization for treatment.

If you have an asthma attack that does not respond to your usual bronchodilator inhaler, this is considered to be a medical emergency. These severe attacks require immediate emergency care.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on July 27, 2016


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.

© 2016 WebMD, LLC. All rights reserved.