What Is An Asthma Attack?

The sudden onset of asthma symptoms that get progressively worse is called an asthma attack.¹Symptoms include wheezing, coughing, shortness of breath, and chest tightness, or any combination of these. The symptoms of an attack prevent you from doing normal activities. They are severe enough that a change in treatment is necessary.² In some asthma attacks, symptoms develop over several days and gradually get worse.

Other terms for an asthma attack are “flare-up,” “exacerbation” and “episode.”² Many people use these terms interchangeably. However, it is common to describe an “asthma attack” as a sudden change in symptoms, whereas an “asthma flare-up” is more gradual. The medical term for someone having a very severe attack is ‘status asthmaticus.’

Why do they happen?

An attack is usually triggered by something such as a viral infection, allergen, or irritant.² Children are especially vulnerable to asthma attacks in damp environments and when they are exposed to secondhand smoke.³

Asthma attacks are more likely for people whose asthma is not well controlled.¹ People with mild and well-controlled asthma can also have an attack, especially when they have a cold.

Speak with your health care provider about what to do if you have symptoms of an asthma attack. Your provider can give you a written asthma action plan that describes how to treat your asthma based on your symptoms.¹

How common are asthma attacks?

About half of people with asthma report having had an asthma attack in the prior year.⁴ Attacks are most common in children, people living in the West and South, and low-income adults.

What are early signs of an asthma attack?

Early signs of an asthma attack include:^1,5

• Fatigue
• Being irritable or short-tempered
• Feeling nervous or edgy
• Coughing
• Wheezing
• Feeling out of breath, gasping for air, fast breathing
• Chest tightness
• Peak expiratory flow less than 80% of predicted or personal best

You may notice other signs of an attack. Try to remember what symptoms you felt before your last asthma attack, so that you can be alert for another one.

When should I go to the hospital?

Speak with your provider about the signs of a severe asthma attack and whether you should seek emergency medical attention. Work with your provider to develop a written asthma action plan that lists what steps should be taken if an attack worsens.

People who are at a high risk of having a fatal attack should do an initial treatment and immediately seek medical help. The risk of death from asthma is higher if you:¹

• Had a previous severe attack requiring intubation or stay in intensive care
• Had two or more hospital stays for asthma in the past year
• Frequently visit the emergency department for asthma
• Refill your rescue medication more than twice per month
• Have heart disease or another chronic lung disease
• Have trouble recognizing the signs of a serious attack
• Use street drugs

Signs of a severe attack that require initial treatment and immediate medical help are:^1,6

• Your inhaler is not helping
• Your symptoms are getting worse
• You feel short of breath when sitting
• You can only speak in words, not using sentences or phrases
• You feel agitated or drowsy
• You hear loud wheezing on inhalation and exhalation
• Your heart rate is above 120 beats per minute (for adults)
• Your fingers and lips are turning grey or blue
• Your peak expiratory flow is less than 50% of personal best

Asthma attacks in infants and children

Infants with severe wheezing should be seen by a doctor.¹ Infants have a higher risk of respiratory failure due to an asthma attack. Respiratory failure happens when too little oxygen passes from the lungs to the blood. Viruses cause most asthma attacks in infants, so the child may also have a fever.

It can be difficult to tell how severe an attack is in young children and infants.¹ The Table lists signs and symptoms of mild, moderate, and severe attacks.¹ Some of these are the same signs as in adults. However, children have higher normal heart and breathing rates.

Severity

During a mild attack

• Breathlessness while walking
• Can lay down
• Talks in sentences
• May seem agitated
• Increase in breathing rate
• Appearance during breathing is normal
• Pulse per minute:
  • Adults: Less than 100 beats/minute.
  • Children: See footnote

During a moderate attack

• Breathlessness while at rest. Person prefers sitting.
  • Infants: May have shorter, softer cries and difficulty feeding
• Talks in phrases
• Can be agitated
• Increased breathing rate
• Common to see skin pull in at the base of ribs and neck
• Pulse per minute:
  • Adults: 100-120 beats/minute.
  • Children: See footnote
• Peak expiratory flow (for adults and older children): 40-69% of personal best

During a severe attack

• Breathlessness while at rest. Person prefers sitting upright.
  • Infants: stops feeding
• Talks in words
• Usually agitated
• Breathing rate:
  • Adults: More than 30 breaths/minutes.
  • Children: See footnote
• Usually able to see skin pull in at base of neck and ribs
• Pulse per minute:
  • Adults: More than 120 beats/minute.
  • Children: See footnote
• Peak expiratory flow (for adults and older children): <40% of personal best

How are they treated?

Mild asthma attacks may be treated at home using a rescue medication, usually a short-acting beta-agonist (SABA).¹ Use a spacer or nebulizer to make sure the medication gets to the lungs.⁶ Your health care provider may recommend additional medications.

Moderate or severe attacks are usually treated in a doctor’s office or emergency department. You may be given oxygen and treated with inhaled or IV medications.

Preventing asthma attacks

Good asthma control helps to prevent an asthma attack. Develop an asthma action plan.¹ Take your medications as recommended. Talk with your provider if you have asthma symptoms despite taking your medications regularly.

Avoid or remove allergens and irritants from the environment. For example, do not allow people to smoke inside the home.¹