Acute severe asthma treatment: what you need to know

Treatment commonly includes oxygen when levels are low, repeated inhaled reliever medicine, and corticosteroids to reduce airway inflammation. The clinical team monitors breathing closely and can add further medicines or breathing support if the response is inadequate.

During a severe attack, tightened airway muscles, swollen airway lining and mucus substantially restrict airflow. Breathlessness may make walking or speaking difficult, while wheezing, coughing and chest tightness can become intense. A quiet chest is not reassuring because very limited airflow may produce little sound.

Clinicians assess speech, alertness, breathing effort, oxygen level, pulse and airflow. They also look for triggers such as infection, smoke, allergens, missed preventer treatment or exposure to an irritant, but emergency treatment begins without waiting for a trigger to be confirmed.

Sit upright, stay with the affected person and use their reliever inhaler exactly as directed in their written asthma action plan. A spacer should be used if the plan includes one. Call emergency services promptly when symptoms are severe, worsening quickly or not improving after reliever medicine; do not drive yourself if breathing is badly impaired.

In emergency care, reliever medicine may be delivered through a spacer or nebuliser. Corticosteroids are usually given early, and additional medicines may be used when the initial response is poor. After stabilisation, the team reviews inhaler technique, preventer treatment, possible triggers and a written plan for future attacks.

Call emergency services immediately if the person cannot finish sentences, is gasping, becomes drowsy or confused, develops blue or grey lips, collapses, or has little relief from their rescue medicine. Rapid deterioration, marked exhaustion and reduced wheezing despite worse breathlessness are also danger signs.

Continue the emergency steps in the person's asthma plan while help is on the way. Do not lie them flat, leave them alone, or delay the call to search for a possible trigger.

Ask what may have triggered the attack, whether your preventer and reliever medicines need changing, and how to check that your inhaler and spacer technique is effective. Request a written action plan that names your early warning signs, the medicine to take and the point at which you should seek urgent help.