Having an asthma attack

1. Follow the Person’s Asthma Plan, if Possible

  • Find out if the person has an individualized asthma action plan from a health care provider.
  • If so, follow its directions for giving asthma medication and seeking medical help for acute asthma attack.

2. Give Asthma First Aid

If the person doesn’t have an asthma plan:

  • Sit the person upright comfortably and loosen tight clothing.
  • If the person has asthma medication, such as an inhaler, assist in using 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.

3. Use Inhaler With a Spacer, if Possible

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

4. Use Inhaler Without a Spacer, if Necessary

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

5. Continue Using Inhaler if Breathing Is Still a Problem

  • After four puffs, wait four minutes. If the person still has trouble breathing, give another set of four puffs.
  • If there’s still little or no improvement, give 4 to 8 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 4 to 8 puffs as needed every 1 to 4 hours..

6. Monitor the Person Until Help Arrives

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

7. Follow Up

  • An emergency room doctor will check the severity of the attack and provide treatment, including medications.
  • The person may be discharged home or hospitalized for further care, depending on response to treatment.

Friends

What Should I Do if My Friend Is Having an Asthma Attack?

What should I do if my friend is having an asthma attack?
– Zahara*

An asthma flare-up can be scary, both for the person having it and anyone who sees it happening. A friend who knows how to handle the situation can be a big help.

Here’s what to do:

  • Stay calm and be reassuring. Help your friend relax. If someone who is having a flare-up panics, it can make it even harder to breathe.
  • Take your friend away from any possible asthma triggers, like smoke.
  • Have your friend sit upright. Lying down might make breathing more difficult.
  • If your friend can talk, ask what his or her asthma action plan says to do during a flare-up. If your friend is able to tell you, follow the plan.
  • If your friend can’t speak or doesn’t remember what to do, ask if he or she has an inhaler to use during flare-ups. If so, get the inhaler and help your friend to use it.
  • Call 911 if:
    • the inhaler doesn’t help
    • the inhaler helps at first but then your friend gets worse again
    • an inhaler is not available
    • your friend is having trouble talking or is struggling to breathe
    • your friend’s lips are turning blue
    • your friend becomes unconscious

Friends can be the first line of defense for someone who is having an asthma flare-up. So it’s great that you want to be prepared!

Reviewed by: Larissa Hirsch, MD
Date reviewed: May 2014

*Names have been changed to protect user privacy.

5 Things to Do If You’re Having an Asthma Attack That Could Save Your Life

An asthma attack is a sudden worsening of asthma symptoms caused by a tightening of the muscles around your airways. But asthma attacks–also called asthma exacerbations–aren’t the same for everybody.

“People with asthma can have different levels of symptoms,” says Melinda Rathkopf, MD, a physician with the Allergy, Asthma and Immunology Center of Alaska. “What makes an attack for you may be different from me.”

Individual attacks may bring slightly different symptoms or severity of symptoms, but they all have one thing in common: a rapid change from your normal symptoms (which, with good management, may be zero).

“It’s sudden,” says Marilyn Li, MD, associate professor of pediatrics at the University of Southern California Keck School of Medicine. “It’s a distinct event.”

Symptoms of an asthma attack can include difficulty breathing, wheezing, coughing, mucus production, shortness of breath, chest tightness or pressure, and even trouble talking or hypoxia (when your lips or fingernails turn blue due to lack of oxygen). These last two, though, are “pretty extreme,” says Dr. Rathkopf.

RELATED: How to Prevent Asthma Attacks

Triggers of an asthma attack vary from person to person, but the two main causes are allergies or infections, says Dr. Rathkopf, also a clinical professor of pediatrics at the University of Washington School of Medicine.

For people with allergic asthma, common triggers are pollen (especially during certain seasons), mold, dust mites, cockroaches, and pet dander, especially from cats.

“Cat dander tends to be stickier and gets caught in the airways,” says Dr. Rathkopf.

Upper respiratory infections like a cold, the flu, or sinusitis are also common causes of an asthma attack.

Other possible triggers include cigarette smoke, perfumes and fragrances, stress and strong emotions, cold air, exercise, acid reflux, and even bad weather. Certain weather-related events, such as high winds, can aggravate asthma.

“When the Santa Ana winds start, they blow everything off the bushes or ground so it’s airborne for a while,” says Dr. Li. Those airborne elements–pollen, dirt–easily get into your airways and precipitate an attack.

RELATED: 7 Signs You Could Have Asthma

Home remedies for asthma attacks

While some asthma attacks are mild, lasting just a few minutes, others are severe and may need immediate medical treatment. Many milder attacks can be handled at home. Here’s what to try.

Avoid your triggers. If you know what your triggers are, try to stay away from them so you can avoid asthma attacks altogether. Sometimes, this isn’t possible–but if you find yourself having an asthma attack and you know why, do what you can to get away from the culprit.

“If you walked into someone’s house with a cat, then get outside,” says Dr. Rathkopf. “If you’re outside and it’s cold, then get inside or cover up your mouth with a scarf.”

Follow your action plan. “Every patient should leave their doctor’s office … with an asthma action plan,” says Dr. Li. These individualized plans will guide you through the best next steps during an asthma attack.

“Preparation is key,” says Dr. Li. “Attacks happen.”

That goes for everyone–even if you’ve never had an asthma attack. “Patients have felt like they can’t really have asthma because they’ve never had an attack,” says Dr. Rathkopf. “That’s fortunate for them, but it doesn’t mean they couldn’t have one.”

The first step after getting away from your trigger–or if you can’t avoid your trigger or don’t know what it is–is usually medication.

Take your rescue inhaler. “Every asthmatic should have a rescue medication–generally some form of albuterol inhaler–and the idea is to carry that on you all the while … even if you haven’t needed it for a long time,” says Dr. Rathkopf. These are usually quick-acting bronchodilators, meaning they open up the airways to help you breathe more easily. “For severe asthma, can prescribe an injectable epinephrine, but that’s rarely necessary,” Dr. Rathkopf adds.

Take anywhere from two to four puffs, advises Dr. Li.

Stay calm. It may be easier said than done, but it often helps to relax your upper body and slow down your breathing during an asthma attack. “You don’t want to have a panic attack on top of it,” says Dr. Rathkopf. “It’s separate from an asthma attack, but coexist with one.

Get medical help. If you’ve had an asthma attack before, you’ll probably have a good idea of how this attack will play out. “The highest risk of a severe attack is a history of a severe attack,” says Dr. Rathkopf. “Prior symptoms really predict future reactions.”

If you don’t feel better after one round of your rescue inhaler, repeat the process if your action plan calls for it. After that, you should seek medical attention, either at the emergency room or your doctor’s office, especially if you have a respiratory infection. In these cases, rescue medications might work, but there’s a good chance you’ll need more help.

Some signs that you need emergency medical treatment are not being able to speak because of shortness of breath; not feeling better after using your rescue inhaler; and straining your chest muscles just to breathe.

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How to Help Someone Having an Asthma Attack

Zac Kennett still remembers the day when his grandmother found him having an asthma attack. He was supposed to be waiting for her in the foyer, but when she saw that he wasn’t there, she came inside and saw him gasping for breath in his bedroom.

Kennett’s grandmother knew that he had asthma and allergies — but she’d never seen him having an asthma attack before.

“It feels almost as if you’re being choked, but it’s prolonged,” says Kennett, of St. Peters, Missouri. Although he doesn’t know what triggered his asthma attack that day, he said that “without proper medicine and medical care, it wasn’t going to fix itself.”

If you see someone having an asthma attack, follow these steps.

Understanding an Asthma Attack

Difficulty breathing is usually the first sign of an asthma attack. This is caused by inflammation in the airways that then stimulates a tightening of the surrounding muscles. When this occurs, a person can experience coughing spells, wheezing, a tightening of the chest, or an inability to move air out of the chest.

Many people mistakenly think asthma attacks always go hand-in-hand with wheezing, but “this is not always the case,” says Ernesto Ruiz-Huidobro, MD, an allergist at Allergy and Asthma Healthcare in Lake St. Louis, Missouri. “To wheeze, you have to move air, so if they are really obstructed, they may not be moving air.”

Other symptoms may include a blue or gray tinge to the fingers or lips, difficulty speaking, or difficulty doing simple chores or other activities, according to the American Academy of Family Physicians (AAFP).

“Asthma is extremely variable,” Dr. Ruiz-Huidobro says. And there’s no average time for an asthma attack to last. While some are mild and can be managed at home, others require treatment at a hospital.

What to Do During an Asthma Attack

Thanks to advances in treatment options, asthma attacks are rarer than they once were. But unfortunately, some people still experience them. Here’s what to do in an emergency:

  • Keep calm. That goes for you and who you’re trying to help. Reassure the person that you’re there for them, says Ruiz-Huidobro. People who are panicked can have difficulty breathing, so you don’t want to worsen an already stressful event by seeming panicked yourself, he explains.
  • Help them sit up. If the person is sitting in an upright position, his or her breathing will be as unobstructed as possible.
  • Eliminate the trigger. If you know the person’s history of asthma attacks, get them away from the trigger or remove the trigger, if possible, says Ruiz-Huidobro. (Example: If you’re near people who are smoking, move away from them.) The list of potential asthma triggers is lengthy — pollen, dust mites, mold, feathers, animal dander, certain foods, smoke, dirt, gases, illness, exercise, stress, cold weather or windy weather, and even acetaminophen — so if you don’t know the person’s triggers, ask them directly, if possible.
  • Follow the emergency plan. If the person has an emergency plan on them — and this may include rescue inhalers (albuterol, in most cases), bronchodilators, and other anti-inflammatory agents — follow the directions. Read the label to determine the appropriate doses of medication and make sure the person follows through with the instructions. Then, ask about his or her action plan for worsening symptoms — whether you should help them use rescue inhalers or breathing treatments, or if you should call an ambulance at the first signs of chest tightening.
  • Assess the severity of the attack. Look for any signs that this is a severe attack — i.e., one that warrants a trip to the emergency room or at least a call to the physician. Signs include skin that looks sucked in between the ribs and on the neck, a bluish discoloration of the lips, and a continuing struggle to breathe several minutes after using a rescue inhaler.

Even if symptoms improve after these steps, encourage the person to call his or her doctor to discuss additional treatments or changes to the current treatment regimen, the AAFP suggests.

Finally, recognize when your actions aren’t enough. If the steps in the emergency plan aren’t working, or if there is no plan, consider going to an urgent care center or calling an ambulance immediately. “The sooner, the better,” Ruiz-Huidobro says. “You have no way of treating it, and asthma attacks usually don’t just go away on their own.”

Asthma Attack

Is this your child’s symptom?

  • Your child is having an asthma attack
  • Use this guide only if a doctor has told you your child has asthma

Symptoms of Asthma

  • Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
  • Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.
  • The diagnosis of asthma requires attacks of wheezing that recur. The diagnosis is rarely made before 1 year of age.

Causes (Triggers) of Asthma Attacks

  • Infections that affect breathing (like colds or the flu)
  • Pollens (trees, grass and weeds)
  • Animals (like cats or rabbits)
  • Tobacco smoke
  • Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
  • Food Allergy (Serious). Asthma attacks caused by food allergy can be life-threatening (anaphylaxis). Examples are nuts or fish.

Asthma Attack Scale

  • Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard or mild. (Green Zone: Peak Flow Rate 80-100% of normal rate)
  • Moderate: SOB at rest. Speaks in phrases. Wants to sit (can’t lay down flat). Wheezing can be heard. Retractions are present (ribs pull in with each breath). (Yellow Zone: Peak Flow Rate 50-80% of normal rate)
  • Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. (Red Zone: Peak Flow Rate less than 50% of normal rate)
  • Peak Flow Meter: a peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs. A PFR can be used in children 6 years and older.

When to Call for Asthma Attack

Call 911 Now

  • Wheezing and life-threatening allergic reaction to similar substance in the past
  • Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Pulse oxygen level less than 90% during asthma attack
  • Lips or face have turned bluish during coughing
  • Ribs are pulling in with each breath (retractions)
  • PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone)
  • Wheezing not gone 20 minutes after using neb or inhaler
  • Breathing is much faster than normal
  • Nonstop coughing not better after using nebulizer or inhaler
  • Severe chest pain
  • Need to use asthma medicine (neb or inhaler) more often than every 4 hours
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Mild wheezing lasts more than 24 hours on neb or inhaler treatments
  • Sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Don’t have written asthma action plan from your doctor
  • Use an inhaler, but don’t have a spacer
  • Miss more than 1 day of school per month for asthma
  • Asthma limits exercise or sports
  • Asthma attacks wake child up from sleep
  • Use more than 1 inhaler per month
  • No asthma check-up in more than 1 year
  • You have other questions or concerns

Self Care at Home

  • Mild asthma attack

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Asthma Attack

  1. What You Should Know About Asthma:
    • Over 10% of children have asthma.
    • Your child’s asthma can flare up at any time.
    • When you are away from your home, always take your child’s medicines with you.
    • The sooner you start treatment, the faster your child will feel better.
    • Here is some care advice that should help.
  2. Asthma Quick-Relief Medicine:
    • Your child’s quick-relief (rescue) medicine is albuterol or xopenex.
    • Start it at the first sign of any wheezing, shortness of breath or hard coughing.
    • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
    • Repeat it every 4 hours if your child is having any asthma symptoms.
    • Never give it more often than 4 hours without talking with your child’s doctor.
    • Coughing. The best “cough med” for a child with asthma is always the asthma medicine. Caution: Don’t use cough suppressants. If over 6 years old, cough drops may help a tickly cough.
    • Caution: If the inhaler hasn’t been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
    • Use the medicine until your child has not wheezed or coughed for 48 hours.
    • Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
  3. Asthma Controller Medicine:
    • Your child may have been told to use a controller drug. An example is an inhaled steroid.
    • It’s for preventing attacks and must be used daily.
    • During asthma attacks, keep giving this medicine to your child as ordered.
  4. Allergy Medicine for Hay Fever:
    • For signs of nasal allergies (hay fever), it’s okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
  5. Fluids – Offer More:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • Reason: It will loosen up any phlegm in the lungs. Then it’s easier to cough up.
  6. Humidifier:
    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
  7. Avoid Tobacco Smoke:
    • Tobacco smoke makes asthma much worse.
    • Don’t let anyone smoke around your child.
  8. Avoid or Remove Triggers:
    • Shower to remove pollens or other allergens from the body and hair.
    • Avoid known causes of asthma attacks (such as smoke or cats).
    • During attacks, reduce exercise or sports if it makes your child’s asthma worse.
  9. What to Expect:
    • If treatment is started early, most asthma attacks are quickly brought under control.
    • All wheezing should be gone by 5 days.
  10. Inhaler With a Spacer: How to Use
    • Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber).
    • Step 2. Breathe out completely and empty the lungs.
    • Step 3. Close the lips and teeth around the spacer mouthpiece.
    • Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer.
    • Step 5. Breathe in slowly until the lungs are full.
    • Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
    • If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
  11. Metered Dose Inhaler (MDI): How to Use Without a Spacer (if you don’t have one)
    • Step 1. Shake the inhaler well.
    • Step 2. Breathe out completely and empty the lungs.
    • Step 3. Close the lips and teeth around the inhaler mouthpiece.
    • Step 4. Press down on the inhaler to release a puff. Do this just as your child starts to breathe in.
    • Step 5. Breathe in slowly until the lungs are full.
    • Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
    • If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
    • Ask your doctor for a spacer if you don’t have one. It will help send more medicine into the lungs.
    • Older children who don’t like a spacer can be prescribed an albuterol dry powder device.
  12. Home Nebulizer: How to Use:
    • A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment.
    • Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline.
    • Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist.
    • Step 3. Turn on the air compressor. It will start making the fine mist that your child needs.
    • Step 4 for an Older Child. Place the mouthpiece between your child’s teeth and seal with the lips. Ask your child to breathe slowly and deeply. Ask your child to hold a deep breath for 10 seconds once a minute.
    • Step 4 for a Younger Child. If your child refuses the mouthpiece, use a face mask. It should cover the nose and mouth. It should fit snugly.
    • Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes.
    • Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: It can’t produce mist if it becomes clogged up.
    • Caution: Closely follow your doctor’s instructions. Use the exact amount of med your doctor ordered. Don’t give a neb treatment more often than every 4 hours.
  13. Call Your Doctor If:
    • Trouble breathing occurs
    • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
    • Wheezing lasts over 24 hours
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 03/14/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

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