Acute asthma exacerbation: signs and immediate action

Use the reliever inhaler exactly as set out in your personal asthma action plan, sit upright, and move away from a known trigger. If the reliever is not helping, symptoms are severe, or speaking and walking become difficult, call emergency services.

Muscles around the breathing tubes tighten while the lining swells and produces mucus. The narrowed passages make it particularly difficult to breathe out. Asthma commonly presents with variable wheeze, cough, breathlessness, and chest tightness, but a very severe attack may produce little wheeze because airflow is extremely limited.

Viral respiratory illness, smoke, dust, strong scents, exercise, weather changes, allergens, or missed preventer treatment may contribute. Sometimes no clear trigger is found. Allergic rhinitis and house dust mite allergy can coexist with asthma and may need their own management.

Stay upright and try to keep breaths steady. Follow the dose and timing in your written action plan, using a spacer with a metered-dose inhaler if that is part of your prescribed technique. Ask someone to remain with you, and do not drive yourself if breathing is significantly impaired.

Clinical treatment may include repeated inhaled bronchodilator medicine, oxygen when the level is low, and a corticosteroid to reduce airway inflammation. Nebuliser treatment may be selected for some attacks, but needing a nebuliser is a clinical decision and does not replace assessment of attack severity.

Call emergency services when breathlessness is rapidly worsening, the prescribed reliever gives little or short-lived benefit, or the person cannot speak comfortably, walk, eat, or drink. Blue-grey lips, drowsiness, confusion, exhaustion, fainting, or a quiet chest are critical warning signs.

Arrange prompt medical review after any flare requiring more reliever than usual, night waking, or interruption of normal activity. Review is also needed after emergency treatment, even when breathing feels better, because airway inflammation and the risk of another deterioration may persist.

Ask the clinician to watch your inhaler and spacer technique, explain which medicine is the preventer and which is the reliever, and update your written action plan. Discuss likely triggers, when to restart activity, whether associated nasal allergy needs treatment, and the exact signs that should lead you back to urgent care.