Near-fatal asthma: what to know

During a severe attack, airway muscles tighten, the lining swells, and mucus can obstruct airflow. Breathing may become fast and exhausting; wheezing can be loud, faint, or absent when very little air is moving. Chest tightness, cough, difficulty speaking, a hunched posture, blue or grey lips, confusion, or unusual drowsiness are warning signs. A person may not accurately judge severity, so a quiet chest is not reassuring when breathing is poor.

Triggers can include infections, allergens, smoke, or missed preventer treatment, but a trigger is not always obvious. Severe asthma can occur in someone whose earlier attacks seemed manageable. A personalised action plan helps separate routine symptoms from an emergency.

Follow the person's prescribed asthma action plan and use the reliever inhaler with a spacer if one has been provided. Sit upright, stay with the person, and call emergency services when symptoms are severe, worsening, or not settling promptly according to the plan. Do not make them lie flat, drive them yourself while they are struggling to breathe, or use someone else's medicine. Emergency clinicians may provide oxygen, inhaled medicines, steroids, and other support; nebuliser treatment may be used when clinically appropriate.

Call emergency services immediately for severe breathlessness, inability to speak in full sentences, blue or grey colouring, exhaustion, confusion, collapse, a silent chest, or poor response to the reliever. A rapidly worsening attack also needs emergency help. Asthma symptoms can deteriorate even when the person stops wheezing, so improvement should be judged by breathing and alertness rather than sound alone.

Ask how to recognise your personal danger signs, exactly when to call emergency services, how to use a spacer, and whether your action plan needs updating. Review preventer use, inhaler technique, trigger reduction, and follow-up after any severe attack.