Acute bronchial asthma: recognising an asthma flare

An episode may bring wheezing, cough, chest tightness, breathlessness or difficulty speaking comfortably. Follow your written asthma action plan and use the prescribed reliever exactly as directed. Severe symptoms or poor response to reliever medicine need emergency care.

During an asthma flare, muscles around the bronchial tubes tighten while the airway lining becomes inflamed and may produce extra mucus. Less space remains for air to move, particularly when breathing out. Wheezing can occur, but a very severe attack may produce little sound because airflow is markedly reduced.

Triggers differ between people and may include respiratory infection, smoke, dust, strong scents, exercise, weather changes or allergens. Allergic rhinitis and house dust mite allergy can coexist with asthma, so controlling nasal allergy and reducing known exposure may support overall symptom control.

Sit upright, stay as calm as possible and move away from a known trigger if this is safe. Use your prescribed reliever inhaler with the technique and dose set out in your action plan; a spacer may help when one has been recommended. Do not lie flat or rely on steam, caffeine or unprescribed remedies in place of asthma medicine.

Once breathing settles, arrange follow-up to review what triggered the episode, inhaler technique, medicine use and whether the action plan needs updating. Frequent reliever use, night waking or activity limitation can signal that background asthma control needs review.

Call emergency services if breathing is rapidly worsening, the reliever is not helping as expected, speech is limited to short words, the chest or neck pulls in with each breath, lips look blue or grey, or the person becomes exhausted, confused or less responsive. Keep using emergency medicine according to the action plan while help is on the way.

Do not drive yourself during a severe attack. A child with marked difficulty feeding, unusual sleepiness, grunting or pronounced rib movement also requires immediate assessment.

Request a written action plan that names your usual controller medicine, your reliever instructions and the signs for seeking help. Ask for an inhaler technique check, guidance about exercise and triggers, and advice on what to do if symptoms interrupt sleep or return soon after a flare.