Prevention and Control of Asthma Attacks

What to Do If You're Having an Asthma Attack

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Man about to use asthma inhaler
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An asthma attack is a sudden worsening of your asthma symptoms caused by a narrowing of your airways, or bronchoconstriction, as a result of inflammation, swelling, and mucus. It can be a scary experience, leaving you to struggle for breath while feeling a tightening of your chest, as if a huge weight is resting on it.

For anyone who has asthma, an asthma care plan is essential to prevent the worsening of your symptoms and a full-on asthma attack.

This will also act as a guide for when you should seek emergency help.

Overview

Asthma attacks—or any acute change in asthma symptoms that interrupt your normal routine and require either extra medication or some other intervention to breathe normally again—are more common among:

  • Children 5 years of age and younger
  • Adults in their 30s
  • Adults over the age of 65

An asthma attack can be fatal, though only one-third of asthma deaths occur in the hospital. This means that many asthma patients are either not recognizing the symptoms indicating they need emergency care, not seeking care, or are not being hospitalized with their worsening asthma.

This is a startling realization, which is why it's important that everyone with asthma understands what to do in case of an attack. It may save your life or that of your child or someone around you. The first step is to work with your doctor to create an asthma care plan.

Asthma Care Plan

The asthma care plan is your guide to determining how well your asthma is controlled. It identifies what actions need to be taken when your asthma worsens and helps you recognize the early warning signs of an asthma attack. It will also help you do the day to day things required to prevent an attack.

With your input, your doctor will develop your asthma care plan. Most plans have three components:

  1. Stage of severity, identified by the peak expiratory flow rate.
  2. A list of symptoms to watch for.
  3. Specific actions to take based on peak flow or symptoms.

Make sure you understand the plan and do not be afraid to ask questions. Share this information with any caregivers and schools so they understand the asthma care plan as well.

In terms of prevention, the action plan will identify all of your known triggers and the things that you need to do to avoid them. Additionally, the plan will list your controller medications and how you should be taking them.

Essentially, your action plan is a tool that will monitor your symptoms using the familiar stoplight as a guide. When you are in the green zone, everything is good. In the yellow zone, you need to be cautious, and the red zone is impending trouble.

You will know what zone you are in by tracking either peak flows or symptoms. Each zone will have specific actions for you to take to improve your asthma control. Think of the asthma action plan as your road map to better breathing and improved asthma symptoms.

Risk Factors

A number of different asthma risk factors may increase your chances of developing an asthma attack.

If you have a diagnosis of asthma, you are at risk for an asthma attack. 

You are at increased risk of a significant asthma attack if you:

  • Have had a serious asthma attack in the past
  • Required admission to a hospital or intensive care unit to care for your asthma in the last year
  • Develop symptoms suddenly or asthma attacks seem to creep up on you without you noticing a change in your symptoms
  • Require frequent use of your rescue inhaler
  • Have a history of substance abuse
  • Have a history of significant mental illness

Some risk factors are avoidable—such as exposure to smoking and eating certain foods—while others, like family history, are not something you can control or modify.

Finally, there are also a handful of protective asthma risk factors that decrease your risk of asthma.

Additional asthma risk factors in both adults and children include:

  • family history of asthma. If you have a parent with asthma you are two to six times more likely to develop asthma compared to someone whose parents do not have asthma.
  • If you are predisposed to allergic conditions, your risk of asthma increases. Nearly half of children with eczema or atopic dermatitis develop asthma.
  • A personal history of allergies
  • Exposure to second-hand smoke
  • Urban living, especially if there is significant air pollution. Pollutants such as sulfur dioxide irritate the airways leading to constriction and asthma symptoms.
  • Low levels of vitamin D
  • Obesity. Multiple research studies have demonstrated an increase of asthma in people who are overweight and obese. There is some evidence that obesity increases the risk for non-allergic asthma types.
  • Low birth weight
  • Being born in the winter months
  • Workplace exposures to chemicals or other substances that may lead to occupational asthma
  • Gastroesophageal reflux disease (GERD)
  • Sinusitis
  • Antibiotic use in the first year of life
  • Eating a lot of fast food
  • Regular acetaminophen use
  • Ozone exposure. Ozone is a major component of smog that increases traditional asthma symptoms such as wheezing, coughing, and shortness of breath.

Reduce Your Risk

On the other hand, the following things can actually reduce your risk of developing an asthma attack:

  • Breastfeeding (lowers your baby's risk of developing asthma)
  • Attending a daycare
  • Belonging to a larger family
  • Increasing your intake of fruits and vegetables
  • Having access to community resources such as economic development opportunities
  • Eating omega-3 fatty acids found in fish
  • Having an asthma action plan and understand how to implement it

Causes

Indoor and outdoor triggers are among the most common that you need to avoid to prevent worsening asthma. When outside, you're looking at the usual suspects: triggers like pollen, animal dander, and dust are the most common. Yet, we can spend as much as 90 percent of our life indoors, so it's also a good idea to be on the lookout for the following:

  • Dust mites are small indoor insects that cannot be seen with the naked eye. It's important to know what increases your dust mite exposure.
  • Mold thrives in interiors on wet, damp, or humid surfaces like bathrooms, kitchens, and basements. If mold is a problem in your home, controlling moisture may lead to better control of your asthma.
  • The body parts, urine, and droppings of cockroaches and other pests contain specific proteins that can trigger allergy symptoms.
  • Environmental tobacco smoke contains cancer-causing chemicals, such as benzene, vinyl chloride, and arsenic, that may irritate the lungs and lead to asthma symptoms. 

Identifying the allergens that affect your asthma can lead to significant improvements. Either avoid them altogether or develop a plan to deal with the trigger.

Keep in mind, however, that everyone's asthma is different. While these may be common triggers for an attack, they may not apply to you and you may actually be vulnerable to other allergens. That's why it's important to identify those with your doctor and develop the action plan that suits your needs.

Triggers for Children

Children can be prone to more frequent asthma attacks. Seemingly simple things like the common cold or running too hard while playing can trigger an asthma attack. The cold air of autumn and winter and even laughing or crying too hard can cause an attack as well.

Symptoms

Everyone with asthma is different. Some people will have frequent attacks while others may go a long period between attacks. A mild attack may last only a few minutes while a severe asthma attack can go on for hours, or even days.

As someone dealing with asthma, it is very important that you recognize and treat the early warning signs of an asthma attack. Appropriate management early on may prevent a trip to the emergency room or admission to the hospital. Additionally, severe, untreated asthma symptoms can lead to death.

Generally, early warning signs of worsening asthma and an asthma attack include:

  • A drop in peak expiratory flow rate
  • Increased cough/chronic cough
  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Some difficulty performing normal daily activities
  • Individual factors noticed over time that indicate worsening asthma or an asthma attack

You will likely be in the "yellow zone" of the asthma care plan when developing the above symptoms. Based on your asthma care plan, follow the instructions about taking extra doses of quick-relief medications and initiating other treatments like a course of oral corticosteroids. The asthma care plan will have instructions regarding how to proceed and when to call your doctor.

Help Your Child Learn the Symptoms

If your child has asthma, it's important to teach them about symptoms that can lead to an attack. This will help them alert you or their caregiver if they start to feel strange.

How in-depth you get is going to depend on your child's age. Younger kids can be taught their asthma triggers and when to ask for help. Generally, kids 10 and older can be included in the development of their asthma action plan.

Another thing you can do is review what happened during an asthma attack once your child is safe and everyone has calmed down. Talk about what they felt and help them understand why that happened. You can also review what actions everyone took, why they helped, and look for ways to improve on it if it occurs again. 

When to Call a Doctor

Asthma attack symptoms that place you in the "red zone" of your asthma care plan are serious. If you experience any of these, you should begin following those instructions immediately. This should include seeing a healthcare provider for emergency care right away:

  • Wheezing that occurs while breathing both in and out
  • Coughing that has become continuous
  • Difficulty breathing
  • Tachypnea or breathing very fast
  • Retractions where your skin is pulled in as you breath
  • Shortness of breath
  • Difficulty talking in complete sentences
  • Becoming pale
  • Becoming anxious

Most critically, if you experience either of these symptoms, do not delay. Immediately call 911 or your local emergency number:

  • Difficulty walking or talking caused by a severe shortness of breath.
  • Blue lips or fingernails, called cyanosis

Make sure that you keep your emergency numbers and details of who to contact in an emergency situation in an easily identifiable place, like the refrigerator or a bulletin board near your home phone. It is also a good idea to carry this information with you and add it to your cell phone.

Treatments

Most of the time when symptoms are identified and treated early, you will notice a prompt improvement in both peak flow and symptoms. However, you need to be prepared if your symptoms don’t improve.

Peak Flow Meters

A peak flow meter is a key to determining how your asthma is doing and preventing an asthma attack. It tells you how well you are breathing and its use is integral to an effective asthma care plan.

If peak flow numbers are declining, your asthma is getting worse and you need to act quickly to prevent an attack. You need to take medications based on the instructions in your asthma care plan to stop the symptoms from getting more severe and turning into a full-blown attack.

If you are frequently needing to step up asthma treatment because of symptoms, worsening peak flows, or frequent asthma attacks, this is a sign of poor control. Adjustments to your plan may be needed, so be sure to revisit that with your healthcare provider. 

Medications

Understanding the purpose of each medication in your treatment of asthma is very important. Some medications—your rescue inhaler, for instance—are designed for the acute relief of asthma symptoms and an asthma attack. Others are used for the long-term control of asthma.

Taking a long-term beta agonist control medication during an acute asthma attack can actually lead to the worsening of asthma. Your asthma care plan should outline which specific medications to take depending on peak flow and other symptoms.

Breathing Exercises

Stress can worsen your asthma symptoms and the anxiety you feel during an attack may make it worse because it makes your airways constrict even more. The ability to remain calm during such an event can significantly reduce the effects you feel. 

That is easier said than done when you feel like you can't breathe. However, with the confidence of an asthma action plan backed by the consciousness that remaining calm will help, you can notice a difference.

Many people with asthma have turned to deep breathing exercises such as Buteyko. While it will not eliminate your need for a rescue inhaler, it can make a significant difference in your asthma management. This may also be a technique you can rely on if you feel an attack coming on and you don't have your inhaler.

A Word From Verywell

When you or your child's asthma is under control, you should be free of asthma symptoms and able to do most of your normal activities. Prompt identification of an asthma attack and taking the appropriate actions during worsening asthma symptoms will prevent complications and frequent visits to the emergency department.

If you find that asthma attacks are happening more frequently, it's time to reevaluate your action plan with your doctor. Being proactive, knowing your asthma triggers, and making some healthy lifestyle choices, along with proper medication can get your asthma treatment back on track.

Sources:

George RB, Light RW, Matthay RA, Matthay MA. Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.

National Heart, Lung, and Blood Institute. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. 2007.

National Heart, Lung, and Blood Institute. Who Is At Risk For Asthma? 2014.

Toskala E, Kennedy DW. Asthma Risk Factors. International Forum of Allergy & Rhinology. 2015;5:S11-6. doi: 10.1002/alr.21557.

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