Acute asthma attack: signs and immediate action

Use the reliever inhaler exactly as set out in the personal asthma action plan, preferably with a spacer when one has been prescribed. Sit upright, stay with the affected person and move away from smoke or another obvious trigger.

During an attack, muscles around the breathing tubes tighten while the airway lining swells and may produce extra mucus. Asthma commonly presents during an attack with wheezing, cough, chest tightness and shortness of breath, although a very severe attack may produce little wheeze because airflow is extremely limited.

Symptoms can build over hours or appear abruptly. Viral illness, smoke, dust, strong scents, exercise, allergens, missed controller medicine and incorrect inhaler technique can contribute. Identifying a trigger does not replace assessing how hard the person is working to breathe.

Follow the written action plan without delay. Help the person take their prescribed reliever correctly, record when it was used and reassess speech, breathing effort and alertness. Loosen restrictive clothing and keep the person upright; lying flat can make breathing feel harder.

Do not rely on steam, caffeine or someone else's inhaler. If the reliever is unavailable, has expired, provides little relief or wears off unusually quickly, seek urgent medical help. After recovery, arrange follow-up to review controller treatment, inhaler technique and the cause of the attack.

Call emergency services if the person cannot speak in full sentences, is gasping, has blue or grey lips, becomes confused or drowsy, collapses, or has marked pulling-in around the ribs or neck. Also call if symptoms are worsening rapidly or prescribed rescue treatment is not helping.

Continue the action-plan instructions while help is coming and do not leave the person alone. Someone who improves still needs prompt assessment if symptoms return soon, wake them from sleep or interfere with ordinary walking and talking.

Request a written asthma action plan that names your daily medicine, the early signs that should trigger action, and the point at which urgent help is required. Ask for a demonstration of inhaler and spacer technique, and clarify how soon you should be reviewed after an attack.