What Is An Asthma Attack?

An asthma attack is a sudden worsening of asthma symptoms. It may also be called an “episode” or “exacerbation.” Mild asthma attacks can be treated at home. Severe asthma attacks may need treatment in an emergency room.¹

Having an asthma action plan can help you prevent and treat asthma attacks. It should include:¹

• Triggers to avoid
• What to do during an attack
• When to get emergency help

Frequent asthma attacks may be a sign that asthma is not well-controlled. Your doctor may want to adjust the drugs you use for daily control of your asthma. This can help prevent attacks.¹

How common are asthma attacks?

Anyone with asthma can experience an asthma attack. About half of people with asthma say they had an asthma attack in the last year. As treatments improve, rates of asthma attacks are decreasing.²

Some factors that increase the risk of a serious asthma attack include:^1,3

• History of severe asthma attacks
• Previous hospitalizations for asthma
• Using quick-acting (rescue) inhalers more than twice a month
• Certain other chronic (long-term) conditions

What are symptoms of an asthma attack?

Symptoms of asthma attacks vary from person to person. Some common symptoms are:¹

• Severe shortness of breath, coughing, or wheezing
• Chest tightness or pain
• Low peak expiratory flow (PEF) readings (less than 80 percent of your personal best)

If you notice these symptoms, follow your asthma action plan. Treatment at home may improve mild symptoms. Talk to your doctor about when to seek emergency treatment. Your asthma attack may require emergency help if you:^1,4,5

• Cannot speak more than short phrases because of shortness of breath
• Have to strain your chest muscles to breathe
• Have very low PEF readings (less than 50 percent of your personal best)
• Do not show improvement after using your rescue inhaler

Asthma attacks interfere with daily life. They make it hard to do everyday activities. This can include sleeping and working and impact your quality of life. Serious asthma attacks can lead to costly hospital visits. In very serious cases, they can cause you to stop breathing and die.^1,3

What causes an asthma attack?

Asthma makes your airways more sensitive to triggers. Exposure to certain triggers can then make your airway narrow and inflamed. This makes it harder to breathe air in and out. This can lead to an asthma attack.^3,6

Triggers vary from person to person. Common triggers of asthma attacks include:^1,3

• Pollen, pets, mold, and dust mites
• Infections
• Tobacco smoke
• Cold or dry air
• Gastroesophageal reflux disease (GERD)
• Stress

These are not all possible triggers. Sometimes there is no obvious cause of an asthma attack. Talk to your doctor about identifying possible triggers.

How are asthma attacks prevented?

The best way to prevent asthma attacks is to keep asthma well-controlled. This includes:^1,3

• Avoiding triggers
• Taking daily control medicines
• Tracking symptoms
• Following your asthma action plan
• Maintaining a healthy diet
• Exercising regularly

Daily control drugs for asthma treat chronic airway inflammation. They reduce the frequency and severity of asthma attacks. If you still have frequent asthma attacks, talk to your doctor. They can adjust your treatment to control asthma better.³

How are asthma attacks evaluated?

Doctors use symptoms, lung function tests, and functional tests to assess asthma attacks. This can help them understand the severity of an asthma attack. They can then make better decisions about treatments.^3-5

Doctors may grade the severity of asthma attacks in adults with the signs listed in the table. Infants and young children may show slightly different signs.^3,7

Signs used to judge the severity of an asthma attack include:^3,7

• Breathlessness
  • Mild: While talking; able to lie down
  • Moderate: While at rest; prefers sitting
  • Severe: While at rest; prefers sitting upright

• Talking
  • Mild: Full sentences
  • Moderate: Phrases
  • Severe: Words

• Breathing rate
  • Mild: Increased
  • Moderate: Increased
  • Severe: More than 30 breaths per minute

• Wheezing
  • Mild: Moderate
  • Moderate: Loud throughout exhale
  • Severe: Loud throughout inhale and exhale

• Pulse (beats per minute)
  • Mild: Less than 100
  • Moderate: 100 to 120
  • Severe: More than 120

• Peak expiratory flow (percentage of personal best)
  • Mild: Above 70
  • Moderate: Between 40 and 70
  • Severe: Less than 40

How are asthma attacks treated?

Follow your asthma action plan during an asthma attack. Initial treatment involves your quick-acting (rescue) inhaler. Common quick-relief drugs include:^1,3

• Short-acting beta-agonists (SABAs):
  • ProAir^® HFA, Proventil^® HFA, or Ventolin^® HFA (albuterol)
  • Xopenex^® (levalbuterol)
• Combinations of long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICSs):
  • Symbicort^® (budesonide and formoterol)
  • Dulera^® (mometasone and formoterol)
  • Breyna^® (generic version of Symbicort)

Experts now recommend ICS-LABA combinations instead of SABAs alone. This is because ICS-LABAs can be used as both the controller and reliever. They also have a lower risk of future severe asthma attacks.³

If your asthma attack is severe, use your rescue inhaler while seeking medical help. In the emergency room, they will give you stronger drugs to quickly control symptoms. Treatments you may get in the emergency room include:^1,3

• SABAs by nebulizer
• Oral or intravenous corticosteroids
• Short-acting muscarinic antagonists, such as Atrovent^® HFA (ipratropium)
• Intubation, ventilation, and oxygen

Your doctor will tell you what to do after an asthma attack. This may include taking certain medicines. It may also include steps to prevent or treat another attack.