Asthma Attack

Reviewed by Dan Brennan, MD on August 18, 2019

What Is an Asthma Attack?

An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways. This tightening is called a bronchospasm. During the asthma attack, the lining of the airways also becomes swollen or inflamed and thicker mucus -- more than normal -- is produced. All of these factors -- bronchospasm, inflammation, and mucus production -- cause symptoms of an asthma attack such as trouble breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack can include:

  • Severe wheezing when breathing both in and out
  • Coughing that won't stop
  • Very rapid breathing
  • Chest tightness or pressure
  • Tightened neck and chest muscles, called retractions
  • Difficulty talking
  • Feelings of anxiety or panic
  • Pale, sweaty face
  • Blue lips or fingernails
  • Worsening symptoms despite use of your medications

Call 911 if you have any of these symptoms.

Some people with asthma may go for extended periods without having an asthma attack or other symptoms, interrupted by periodic worsening of their symptoms due to exposure to asthma triggers such as exercise or exposure to cold air.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours after treatment. Severe asthma attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms of an asthma attack to help you prevent severe episodes and keep asthma under control.

What Happens if an Asthma Attack Goes Untreated?

Without immediate asthma medicine and asthma treatment, your breathing may become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your reading will probably be less than your personal best.

As your lungs continue to tighten during the asthma attack, you may be unable to use the peak flow meter at all. Gradually, your lungs may tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the "silent chest," and it is a dangerous sign. You need to be taken to a hospital immediately with a severe asthma attack. Call 911 for help. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care.

If you do not receive adequate treatment for an asthma attack, you may eventually be unable to speak and can develop a bluish coloring around your lips. This color change, known as "cyanosis," means you have less and less oxygen in your blood. Without immediate aggressive treatment in an emergency room or intensive care unit, you may lose consciousness and eventually die.

How Do I Recognize the Early Signs of an Asthma Attack?

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

In general, these early asthma attack symptoms are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse.

Early warning signs of an asthma attack may include:

The severity of an asthma attack can escalate rapidly, so it's important to treat these symptoms immediately once you recognize them.

What Do I Do If I Have An Asthma Attack?

If you or a loved one is having an asthma attack and the symptoms don’t get better quickly after following the asthma action plan, follow the "red zone" or emergency instructions and contact your doctor or call 911 right away. You need urgent medical attention.

1. Give asthma first aid.

If the person doesn't have an asthma plan:

  • Sit them upright comfortably and loosen tight clothing.
  • If the person has asthma medication, such as an inhaler, help them take it.
  • If the person doesn’t have an inhaler, use one from a first aid kit. Do not borrow someone else’s. The medicine in it may be different than the needed rescue medicine. Also, using someone else's inhaler has a slight risk of passing on an infection.

2. Use an inhaler with a spacer, if possible.

  • Remove the cap and shake the inhaler well.
  • Insert the inhaler into the spacer.
  • Have the person breathe out completely and put their mouth tightly around the spacer mouthpiece.
  • Press the inhaler once to deliver a puff.
  • Have the person breathe in slowly through their mouth and hold their breath for 10 seconds.
  • Give a total of four puffs, waiting about a minute between each puff.

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3. Use an inhaler without a spacer, if necessary.

  • Remove the inhaler cap and shake well.
  • Have the person breathe out all the way and seal their lips tightly around the inhaler mouthpiece.
  • As the person starts to breathe in slowly, press down on the inhaler one time.
  • The person should keep breathing in as slowly and deeply as possible (about 5 to 7 seconds) and then hold their breath for 10 seconds.
  • Give a total of four puffs, waiting about 1 minute between each puff.

4. Continue using the inhaler if breathing is still a problem.

  • After four puffs, wait 4 minutes. If the person still has trouble breathing, give another set of four puffs.
  • If there’s still little or no improvement, give four to eight puffs every 20 minutes until the ambulance arrives, for up to 4 hours. If you are still waiting for help after 4 hours, the recommended dose is four to eight puffs as needed every 1 to 4 hours.

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5. Monitor the person until help arrives.

  • Do not mistake drowsiness as a sign of improvement; it could mean asthma is getting worse.
  • Do not assume that the person’s asthma is improving if you no longer hear wheezing.

6. Follow up.

  • An emergency room doctor will check the severity of the attack and give treatment, including medications.
  • The person may be sent home or stay in the hospital for further care, depending on their response to treatment.
WebMD Medical Reference

Sources

SOURCES:

American Lung Association: "An Asthma Attack."

National Heart, Lung, and Blood Institute: "What are the Signs and Symptoms of Asthma?" “How Is Asthma Treated and Controlled?”

Handal, K. The American Red Cross First Aid and Safety Handbook, Little, Brown and Company, 1992.

National Asthma Council Australia: “First Aid for Asthma.”

Cleveland Clinic: “How to Use a Metered Dose Inhaler.”

Institute for Clinical Systems Improvement: “Emergency and Inpatient Management of Asthma Emergency Room Management.”

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