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.