Asthma attack

Overview

An asthma attack is a sudden worsening of asthma symptoms. Asthma is a long-term condition that makes breathing difficult because airways in the lungs become narrow. Symptoms of asthma attack include coughing, wheezing, tightness in the chest and difficulty getting enough air.

These symptoms happen because muscles around airways tighten up, the airways become irritated and swollen, and the lining of the airways produces a fluid called mucus. All of these factors make it difficult to breathe.

People who already have a diagnosis of asthma usually have an asthma action plan. This tells them what medicines to take if they have an asthma attack and when to get emergency care. People who do not have a diagnosis or don't have a treatment plan should get emergency care if they have these symptoms.

Frequent asthma attacks show that a person's asthma is not under control. A healthcare professional might make changes in medicines and the asthma action plan to improve control.

An asthma attack also is called an asthma exacerbation or asthma flare-up.

Symptoms

Symptoms of asthma attacks may include:

• Shortness of breath.
• Chest tightness or pain.
• Coughing.
• Wheezing.

Severe symptoms also may include:

• Gasping for breath.
• Difficulty speaking because of shortness of breath.
• Straining of chest muscles to breathe.
• Worse symptoms when lying on the back.
• Severe sweating.

The result of an at-home test, called a peak flow meter, can be an important sign of an asthma attack. This device measures how quickly you can force air out of your lungs. Peak flow readings are usually a percentage of how your lungs work at their best. This is called your personal best peak flow.

An asthma action plan often includes steps to take based on a peak flow reading. A reading below 80% of a best peak flow can be a sign of an asthma attack.

When to see a doctor

An asthma action plan tells you when to call your healthcare professional and when to get emergency care. A plan has three parts with color codes:

• Green. The green zone of the plan is for times you are feeling well and have no asthma symptoms. The plan tells you what dose of long-term control medicine to take every day. It also tells you how many puffs of a quick-relief inhaler to take before you exercise. If you use a peak flow meter, readings should be 80% or higher of your best.
• Yellow. The yellow zone tells you what to do if you have asthma symptoms. It explains when to use a quick-relief inhaler and how many puffs to take. It also describes what to do if your symptoms don't improve and when to call your care team. Peak flow readings are 50% to 79% of your best.
• Red. The red zone tells you to get emergency care when symptoms are severe or if symptoms worsen or don't improve after using a quick-relief inhaler. Peak flow readings are below 50% of your personal best.

If you do not have an asthma action plan, get emergency care if quick-relief medicine is not helping symptoms.

Checkups for asthma control

It's important to keep regular appointments with your healthcare professional. If your asthma is under control, you may be able to take lower doses of medicine. If you are using a rescue inhaler too often to treat asthma attacks, you may need changes to your asthma action plan. These might include taking a new medicine or higher doses of a medicine.

Causes

Asthma is usually a lifelong disease of inflammation in the lungs caused by an overactive immune system. Inflammation in the lungs includes the tightening of muscles around airways, swelling of tissues in the airways and the release of mucus that can block airways. When this happens, it's difficult to breathe.

Asthma attacks occur when something triggers the immune system to take action. Triggers may include:

• Allergic reaction to pollen, pets, mold, cockroaches and dust mites.
• Colds, the flu or other illnesses affecting the nose, mouth and throat.
• Tobacco smoke.
• Cold, dry air.
• Exercise.
• A condition called gastroesophageal reflux disease (GERD) that results in stomach acids entering the tube between the mouth and stomach.
• Pollution or irritating chemicals in the air.
• Pain relievers, such as aspirin and nonsteroidal anti-inflammatories, and some other medicines.
• Depression or anxiety.

Risk factors

Anyone who has asthma is at risk of an asthma attack. Factors that can increase the risk include:

• Poorly controlled allergies.
• Exposure to triggers in the environment.
• Not taking daily asthma medicines.
• Incorrect use of inhaler.
• Long-lasting depression or anxiety.
• Other long-term illnesses, such as heart disease or diabetes.

Complications

Asthma attacks affect both a person's health and quality of life. Problems may include:

• Missed days of school or work.
• Frequent emergency or urgent care visits.
• Interrupted sleep.
• Limits on regular exercise or recreational activities.

Severe asthma attacks can cause death. Life-threatening asthma attacks are more likely for people who frequently use quick-relief medicines, have had emergency room visits or hospital stays to treat asthma, or have other long-term illnesses.

Prevention

An important step to prevent an allergy attack is to follow your asthma action plan:

• Take your long-term asthma control medicine every day.
• Take peak flow readings as directed.
• Take your quick-relief medicine before exercise as directed.
• Use quick-relief medicine as stated in your plan.
• Keep track of how often you use quick-relief medicine.

Your input on how well the plan is working helps your healthcare professional adjust the treatment to prevent asthma attacks.

Other steps to prevent asthma attacks include the following:

• Avoid triggers as much as possible.
• Stay indoors when there are poor air quality warnings.
• Get tested for possible allergies and take allergy medicines as directed.
• Wash your hands frequently to lower the risk of getting a cold or the flu.
• Keep current on vaccinations, including annual flu and COVID-19 shots, and others recommended by your healthcare professional.
• Get treatment for depression, anxiety or related conditions.
• If you smoke, quit.
• Wear a mask while cleaning.
• Cover your mouth with a scarf or mask on cold days.

Diagnosis

If your symptoms don't improve with at-home treatment, you will need to see your healthcare professional or get emergency care. Even if symptoms improve with at-home treatment, your healthcare professional may want to see you soon for an exam, depending on the severity of symptoms.

If you go to your clinic or the emergency room for treatment, you will likely get treatments and have tests at the same time. The goal is to improve your breathing, to judge how severe an asthma attack is and to see whether the treatment is working.

Tests to measure how well your lungs are working may include:

• Peak flow meter. This device measures how quickly you can force air out of your lungs. Peak flow readings are usually a percentage of how your lungs work at their best.
• Spirometer. A spirometer measures how much air your lungs can hold and how quickly you can breathe out. This measurement is called forced expiratory volume (FEV-1). Your FEV-1 measurement is compared with the typical FEV-1 for people who don't have asthma. As with your peak flow reading, this comparison is often given as a percentage.
• Pulse oximeter. This small device clipped on the end of a finger measures the amount of oxygen in your blood. This shows how well the lungs are delivering oxygen to the blood.
• Nitric oxide measurement. This exam measures the amount of nitric oxide gas you have in your breath when you exhale. High nitric oxide readings are present when there is swelling or other immune system activity in the lungs. This test would likely not be used in emergency care.

Treatment

The goal of management is to treat an asthma attack at home by following your asthma action plan. At-home treatment may be enough to improve symptoms and make breathing easier.

The instructions in the plan also tell you when to see your healthcare professional or get emergency care.

Yellow zone

The yellow zone of an asthma action plan is having moderate asthma symptoms and a peak flow reading of 50% to 79% of your personal best. If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist.

Quick-relief medicines include:

• Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others).
• Levalbuterol (Xopenex, Xopenex HFA).

The yellow zone of the plan also will tell you:

• When to take another dose of the quick-relief medicine.
• When to take a pill called an oral corticosteroid to treat inflammation.
• Whether to call your healthcare professional.

Your healthcare professional may tell you whether to take additional doses or change doses of a medicine. You'll likely get instructions about monitoring your symptoms. You may be instructed to go to the clinic or emergency room.

Red zone

The red zone in an asthma action tells you to get emergency care if:

• You are very short of breath.
• The symptoms get worse.
• You're still in the yellow zone after 24 hours.
• You can't do typical activities.
• You have a peak flow below 50%.
• Your healthcare professional tells you to go.

Emergency treatment

If you go to the emergency room for an asthma attack in progress, you'll likely get a number of treatments to restore regular breathing. Treatments may include:

• Oxygen. Oxygen may be given through a tube attached to the nose if there are signs of too little oxygen in the blood.
• Quick-relief medicines. Inhaled quick-relief medicines, such as albuterol and levalbuterol, are given either with an inhaler or a nebulizer to open airways.
• Ipratropium (Atrovent HFA). Ipratropium is a drug also used to open airways that is inhaled with an inhaler or a nebulizer.
• Corticosteroids. Corticosteroids are given as a pill or shot to treat inflammation.
• Mechanical ventilation. If an asthma attack is life-threatening, a machine may be used to help you breathe and get extra oxygen. This may be done with a breathing mask. But in some cases, a tube is placed down the throat and into the windpipe. This procedure is called intubation.

You will be in the emergency room or in the hospital for observation or treatment until you are breathing regularly for some time.

You'll be given instructions for:

• What dose of long-term asthma medicine you should take daily.
• What dose of quick-relief medicine to take and when to take it.
• When to follow up with the healthcare professional who regularly manages your asthma treatment.
• When to get urgent or emergency care.

Preparing for an appointment

If you are getting emergency care, bring your asthma action plan and medicine with you if possible. If you are seeing your primary healthcare professional for treatment or a follow-up appointment, you can prepare by doing the following:

• Take your asthma action plan with you. If you don't have one, ask to make one.
• Bring your peak flow meter results and all of your medicines.
• Be prepared to discuss your symptoms, and how much your asthma has been bothering you.
• Be prepared to demonstrate using your peak flow meter and inhaler.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. Some good questions to ask your doctor include:

• Do my medicines or treatment plan need to be changed?
• What are the signs that I may be about to have an asthma attack?
• What can I take to prevent an asthma attack when my symptoms get worse, or when I'm exposed to my triggers?
• What steps do I need to take to stop an asthma attack in progress?
• When do I need to go to the emergency room or seek other emergency treatment?
• I'm having more heartburn. What can I do to prevent this?
• Is it time for my flu or COVID-19 shot? Am I due for a pneumonia shot?
• What else can I do to protect my health during cold and flu season?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your healthcare professional will likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Have you noticed anything that makes your asthma worse?
• What medicines are you taking?
• How often are you using your quick-relief medicine?
• Can you show me how you use your peak flow meter?
• Can you show me how you use your inhaler?
• Are you having any problems with your medicine?
• Can you explain how the asthma action plan works?
• Do you know when to call me or go to the hospital?
• Do you have any questions about your asthma action plan?
• Are you having any problems with your asthma action plan?
• Is there anything you want to be able to do that you can't because of your asthma?