Acute severe asthma: signs and urgent action

Symptoms may include marked wheezing, coughing, chest tightness, rapid breathing and difficulty speaking or walking. A quiet chest during extreme breathlessness is especially concerning because very little air may be moving.

During an attack, muscles around the breathing tubes tighten while the airway lining swells and produces mucus. The narrowed passage makes it hard to move air, particularly when breathing out. Symptoms can worsen quickly after infection, smoke, dust, an allergen, exercise or interruption of preventer treatment.

Clinicians judge severity from breathing effort, ability to speak, alertness, oxygen level, heart rate and a peak-flow reading when it is safe to obtain one. They also look for pneumonia, an allergic reaction or another cause of sudden breathing trouble.

Sit upright, stay with the person and help them use their prescribed reliever inhaler according to their written asthma action plan. A spacer can help medicine reach the lungs. Loosen restrictive clothing and move away from smoke or a known trigger when this can be done safely.

Do not lie the person flat or leave them alone. If relief is incomplete, short-lived or the inhaler is difficult to use, call emergency services. Continue following the action plan while waiting for help and tell responders what medicine has been taken.

Call emergency services immediately if the person cannot complete a sentence, is gasping, becoming exhausted or confused, has blue or grey lips, collapses, or has severe symptoms that are not responding to the reliever. These signs indicate critically restricted airflow or low oxygen.

After any significant attack, arrange prompt clinical review even if breathing settles. The review should check inhaler technique, access to medicines, possible triggers and whether the written action plan and preventer treatment need adjustment.

Ask the clinician to demonstrate correct inhaler and spacer technique, define your personal warning signs and explain when to escalate beyond the reliever. Confirm which daily preventer to take, how to manage likely triggers and where to keep copies of the asthma action plan.