What is an asthma attack?
Asthma is a condition where the airways in your lungs become inflamed and tight, which makes it difficult to breathe. An asthma attack is when your symptoms suddenly become worse than usual.
This can happen because your asthma medications aren’t working as well as usual. Or, it can be due to a trigger, like allergies or a viral infection.
Some asthma attacks can be treated at home by following your doctor’s instructions. But you may have to go to the ER for more severe attacks because it can be life threatening.
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Common asthma attack symptoms
During an asthma attack, it becomes very hard to breathe and your chest feels tight.
- Wheezing. High-pitched whistling sounds when you breathe out
- Shortness of breath. Difficulty catching your breath or getting enough air into your lungs
- Chest tightness and/or pain. May feel like being hugged tightly. Or a band is wrapped around your chest.
The idea of “outgrowing” childhood asthma is a common misconception. We approach asthma like it’s a lifelong disease. Even if you haven’t had symptoms or needed treatment in years, it’s still important to mention to your doctor if you ever have breathing issues again in adulthood. —Dr. Amrita Khokhar
What is the best thing to do when having an asthma attack?
Call 911 or go immediately to the emergency room if you can’t speak in full sentences, you start to feel lightheaded or drowsy, or your medications (such as a rescue inhaler) aren’t working. Someone should let your doctor know that you are going to the emergency room.
You need to have an asthma action plan. An asthma action plan is a guide that you create with your doctor to treat your asthma, including what to do during an asthma attack. It should also address:
- Medications you should be taking on a daily basis to keep asthma under control, if recommended.
- Symptoms that may be a sign that your asthma is worsening and how to know that you might be having an asthma attack.
- If you think you’re having an asthma attack, what medications (such as a rescue inhaler) you should use.
- Information to help you decide when to call your doctor who manages your asthma and when to go directly to the emergency room.
Instructions on using a peak flow meter at home (optional). The device measures your breathing. During an asthma attack, your breathing measurements on the PEF meter will be lower than normal. It can help you determine if you are having an asthma attack.
Asthma attack treatment
There are many ways to treat an asthma attack, depending on how severe your symptoms are.
- Follow your asthma action plan. It provides instructions on what medications to take. You may need to take additional doses of your inhaler. Or you may be prescribed a nebulizer. A nebulizer delivers medication in the form of a mist that can be easier to breath than using an inhaler. It also can deliver a higher dose.
- If you don’t get better with inhalers or a nebulizer, you may need steroids. These can be oral pills prescribed in advance by your asthma doctor. Or, if your symptoms are more severe, you may need to get them intravenously in the ER.
- At the ER, you may be given additional oxygen if you are having a lot of difficulty breathing.
- For a bacterial respiratory infection like bronchitis, you will probably be given an antibiotic.
- If the attack is caused by an allergy, whether environmental like pollen or animal dander, you may be told to take allergy medication. Some examples of allergy medications include cetirizine, loratadine, and fexofenadine.
Treating a child who is having an asthma attack
Take your child to the ER if you notice these symptoms:
- Difficulty breathing. This includes needing to sit up because they can’t breathe lying down, gasping or gulping for air, or having trouble taking a complete breath.
- Breathing with the muscles of their stomach, ribs, and neck. The muscles may look like they’re pulling inwards. It means that they are having to work extra hard to breathe.
- Wheezing constantly, even after taking their rescue medications listed on their asthma action plan.
- Lips or fingernails turning blue.
- Seeming more drowsy than normal. For example, they might fall asleep while playing. Or babies doze off feedings.
Asthma attack causes
An asthma attack occurs when the airways in the lungs become inflamed and the muscles surrounding the airways tighten up.
When this happens, the airways become more narrow, making it difficult to breathe. It can be because your asthma is not being well treated—your medications aren’t working or if you forget to take them. Or due to a trigger, like allergies or a viral infection.
These are some of the triggers that increase your chances of having an asthma attack. Though they vary from person to person.
- Allergens like pollen, pet dander, dust mites, mold, etc.,
- Smoking or being around smoke, or vaping.
- Strong scents like perfume and cleaning products.
- Pollution or industrial chemicals and toxins.
- Having a cold, sinus infection, or the flu. These infections can make inflammation in the lungs worse, which triggers asthma symptoms.
- Exercising, particularly when very intense. Some people experience exercise-induced asthma during or right after their workout.
- Indigestion or gastroesophageal reflux disease (GERD).
- Cold or dry air.
- Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
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How do you know you are having an asthma attack?
The most important question to discuss when you’ve received an asthma diagnosis would be, “What can I specifically do to keep my asthma under control?” This is so important because asthma flare-ups or attacks can put you at risk for complications from asthma. —Dr. Khokhar
The first symptoms of an asthma attack might be coughing or wheezing. (Wheezing is a whistling noise you can hear when you breathe out.) As it becomes worse, you will feel short of breath or have trouble breathing.
Each breath may not feel like you're getting enough air. So you keep trying to get more air into your lungs or breathe faster than usual. Your chest may feel “tight,” almost as if someone is hugging you.
What to do after an asthma attack
Whenever you go to the ER or are hospitalized for asthma, see your doctor who is managing your asthma within a week after you are sent home.
When you are prescribed antibiotics or steroids, follow your doctor’s instructions. Do not skip any doses or stop taking the medication until it’s finished. Even if you feel better.
Tell your doctor about any asthma attacks. Even if the attacks are quick. You may be referred to a pulmonologist (a lung specialist) or an allergist. They can help diagnose and manage more difficult-to-treat forms of asthma.
They may recommend specialized medications or run tests to identify your triggers. For example, an allergist will do allergy testing to look for triggers that are making your asthma worse, like pollen or dust.
Preventing asthma attacks
Asthma research is booming and we are learning so much about the disease. In the last few years, we have seen several new medications come out that are really changing the way we approach the disease. —Dr. Khokhar
There are several steps you can take to help prevent asthma attacks:
- Take your asthma controller medications every day as directed. Don’t skip doses, even if you are feeling well.
- If you’ve been prescribed a spacer, use it with your inhalers. A spacer is a device that increases the amount of medication you’re inhaling into your lungs.
- Do your best to avoid asthma triggers. For example, if your trigger is cigarette smoke, don’t smoke and stay away from places where other people are smoking.
- Follow up with your doctor as recommended. During your follow-up visits, they will review your medication usage and any symptoms that you might be having. They may also check your asthma by doing some tests.