What should you know about a severe asthma attack?

During an attack, inflamed airways tighten and produce more mucus, so air has difficulty moving in and out. You may notice intense breathlessness, wheezing, cough, chest tightness, fast breathing, or difficulty speaking. The person may look exhausted or frightened, but appearance alone does not show how serious the attack is.

A severe attack can happen even in someone whose symptoms were quiet earlier. Infection, allergens, smoke, exercise, missed preventer doses, or an unknown trigger may contribute. The episode is an asthma emergency, not simply a troublesome cough.

Help the person sit upright and stay with them. Follow their written asthma action plan and help them take their prescribed reliever as directed. Remove smoke or another obvious trigger if this can be done safely. Call emergency services promptly when symptoms are severe, worsening, or not improving with the action plan. Keep the person calm and do not make them lie flat or drive them to care yourself.

Call for emergency help if the person cannot finish sentences, is struggling to breathe, becomes drowsy or confused, develops blue or grey lips, or has little improvement after rescue medicine. Emergency clinicians may give oxygen, inhaled treatment through a nebuliser, steroids, and observation. Even after improvement, arrange a review to identify why the attack happened and strengthen the action plan.

Ask what likely triggered the episode, how to recognise your personal early warning signs, how many reliever doses your plan allows, and whether your preventer treatment or inhaler technique needs changing.