Help, I'm Having An Asthma Attack!

Handling worsening asthma symptoms and preventing an asthma attack

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An asthma attack is a sudden worsening of your asthma symptoms caused by narrowing of your airways or bronchoconstriction as a result of inflammation, swelling, and mucus. Both you and your child need to:

Am I At Risk For a Fatal Asthma Attack?

Only one-third of asthma deaths occur in the hospital.

This means many asthma patients are either not recognizing the symptoms that indicate they should be seeking emergent care, not seeking care, or are not being hospitalized with their worsening asthma.

Understand Your Asthma Care Plan to Prevent an Asthma Attack

For anyone who has asthma, an asthma care plan is essential to prevent worsening of your symptoms and an asthma attack. The asthma care plan is your guide to determining how well your asthma is controlled and what actions need to be taken when asthma worsens or when you develop symptoms of an asthma attack. With your input, your doctor will develop your asthma care plan. Most plans have 3 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. Make sure any other caregivers and his/ her school understand the asthma care plan as well.

Avoid Triggers

Indoor and outdoor triggers are among the most common that you need to avoid to prevent worsening asthma. We spend as much as 90% of our life indoors. Dust mites are small indoor insects that cannot be seen with the naked eye. Knowing what increases your dust mite exposure. Environmental tobacco smoke contains cancer-causing chemicals such as benzene, vinyl chloride, and arsenic that may irritate the lungs airways and lead to asthma symptoms.

Molds thrive in interiors on wet damp, humid surfaces like bathrooms, kitchens, and basements. If molds are a problem in your home, controlling moisture may lead to better control of your asthma. Finally, body parts, urine, and droppings of cockroaches and other pests contain specific proteins that can trigger allergy symptoms.

Identifying these indoor allergens affecting your asthma could lead to significant improvements by either avoiding the trigger or developing a plan to deal with the trigger.

Know Your Asthma and Asthma Attack Symptoms:

Everyone with asthma is different. Some people will have frequent attacks while others may go a long period between attacks. You need to monitor your asthma symptoms like chest tightness, wheezing, shortness of breath, and chronic cough. The action plan that you and your child's healthcare provider have developed will list how to treat asthma symptoms.

Know Your Peak Flow:

A peak flow meter is the 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 a key part of the asthma care plan.

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

Know Your Medications:

Understanding the purpose of each medication in the treatment of asthma is very important because some medications are designed for the acute relief of asthma symptoms and an asthma attack and some for the long-term control of asthma. Taking a long-term beta agonist control medication during an acute asthma attack can actually lead to worsening of asthma.

The asthma care plan will outline which specific medications to take depending on peak flow and other symptoms.

Recognize Early Warning Signs of Worsening Asthma & an Asthma Attack

As the parent of a child with asthma or someone with asthma, it is very important that you recognize and treat the early warning signs of an asthma attack. Appropriate management early on in an asthma attack may prevent a trip to the ER, an admission to the hospital or worse. Generally, early warning signs of worsening asthma and an asthma attack include:

  • A drop in peak expiratory flow rate
  • Increased cough
  • Wheezing
  • Chest tightness
  • Some difficulty performing normal daily activities
  • Individual factors you notice over time that indicates worsening asthma or an asthma attack

You will likely be in the "yellow zone" of the asthma care plan when developing these 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.

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.

Make sure you discuss your asthma care plan with your health care provider. If you or your child is frequently needing to step up asthma treatment because of symptoms or worsening peak flows, or frequent asthma attacks, this is a sign of poor control and adjustments to the plan may be needed.

Identify Indications For Emergency Care:

One of the most important skills as a patient or parent of a child with asthma is to know when you need to call your doctor or just head straight to the emergency department. All of the following symptoms are indications that you or your child needs to seek a healthcare provider for emergency care immediately:

  • 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
  • Blue lips or fingernails called cyanosis

If you or your child has any of these symptoms, they are in the "red zone" of the asthma care plan and you should begin following those instructions immediately, which should also include seeing a healthcare provider. 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 phone. It is also a good idea to carry this information with you.

Adult recommendations do not significantly differ for handling an acute asthma flare.

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 and action of an asthma attack and worsening asthma symptoms will prevent complications and frequent visits to the emergency department.


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

Asthma. In Chest Medicine: Essentials Of Pulmonary And Critical Care Medicine. Editors: Ronald B. George, Richard W. Light, Richard A. Matthay, Michael A. Matthay. May 2005, 5th edition.

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