Acute asthma exacerbation: recognising a flare

A flare may begin with more frequent cough, wheeze, night waking or reliever use before breathing becomes obviously difficult. Acting at those early changes can prevent further deterioration, but red-flag breathing symptoms require emergency help.

Inflammation and muscle tightening make the airways narrower than usual, so moving air out of the lungs takes more effort. An asthma exacerbation often presents with increasing wheeze, chest tightness, cough, breathlessness, reduced activity tolerance or disturbed sleep.

Some flares develop after a respiratory infection or exposure to smoke, dust mites, pollen or workplace irritants. Others follow missed controller doses or poor inhaler delivery. More than one factor may be involved, and the absence of a clear trigger does not make worsening breathing less significant.

Use the instructions in your current written asthma action plan, including the prescribed reliever and any clinician-directed adjustment to controller medicine. Check inhaler technique, use a spacer if advised, stay upright and stop exposure to an obvious irritant. Keep track of symptom progression and how long relief lasts.

Contact a clinician promptly if you need the reliever more often than your plan allows, symptoms interrupt sleep or usual activities, or the expected improvement does not occur. Do not start leftover antibiotics or oral steroids unless a clinician has specifically instructed you to do so for this flare.

Get emergency assistance for difficulty speaking, severe breathlessness at rest, blue or grey lips, exhaustion, confusion, fainting, a silent chest or rapidly worsening symptoms. Rescue medicine that brings little or only brief relief is another reason not to wait.

While waiting, remain upright and continue rescue steps from the action plan. After any urgent episode, clinical reassessment can confirm that breathing has stabilised and address the treatment gap or exposure that contributed to the exacerbation.

Discuss which early changes marked this flare, whether your daily control medicine needs adjustment, and whether allergy or infection symptoms need separate management. Have the clinician watch you use each inhaler and confirm when your action plan tells you to escalate care.