What is an asthma attack?


Asthma Attacks

The sudden onset of asthma symptoms that get progressively worse is called as asthma attack.1 Symptoms 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 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, where as an “asthma flare up” is more gradual. The medical term for someone having a very severe asthma attack is ‘status asthmaticus.’

Why do asthma attacks 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 asthma 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

What are early signs of an asthma attack?

  • Fatigue1,4
  • 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 asthma 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 asthma 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:1,5

  • 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

What is important to know about 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.

Table. Asthma Attack Severity

  • While walking
  • Can lie down
  • While at rest
  • Prefers sitting
  • Infants: softer, shorter cry, feeding difficulty
  • While at rest
  • Sits upright
  • Infants: stops feeding
  • Talks in
    May be agitated
    Usually agitated
    Usually agitated
    Breathing ratea
    Adults: More than 30 breaths/minutes Children: See footnote
    Appearance during breathing
    Common to see skin pull in at base of neck and ribs
    Usually able to see skin pull in at base of neck and ribs
    Adults: Less than 100 beats/minute Children: See footnote
    Adults: 100-120 beats/minute Children: See footnote
    Adults: More than 120 beats/minute Children: See footnote
    Peak expiratory flow (for older children and adults)
    ≥70% of personal best
    40-69% of personal best
    <40% of personal best

    Adapted from National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma – Full Report 2007, page 380.

    How are asthma attacks 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.5 Your health care provider may recommend additional medications.

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

    What can I do to prevent an asthma attack?

    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

    How common are asthma attacks?

    About half of people with asthma report having had an asthma attack in the prior year.6 Asthma attacks are most common in children, people living in the West and South, and low-income adults.

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    view references
    1. National Heart, Lung, and Blood Institute. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Full Report 2007. Accessed 11/12/14 at: http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf
    2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014. Accessed 11/12/14 at: www.ginasthma.org
    3. Kanchongkittiphon W, Mendell MJ, Gaffin JM, et al. Indoor Environmental Exposures and Exacerbation of Asthma: An Update to the 2000 Review by the Institute of Medicine. Environ Health Perspect. Epub October 10, 2014. http://ehp.niehs.nih.gov/wp-content/uploads/advpub/2014/10/ehp.1307922.acco.pdf
    4. Medline. Signs of an asthma attack. Accessed 12/10/14 at: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000062.htm
    5. American Academy of Family Physicians. How to Treat an Asthma Attack. Am Fam Physician. 2011;84:40-47. http://www.aafp.org/afp/2011/0701/p49.html
    6. Moorman JE, Person CJ, Zahran HS; Centers for Disease Control and Prevention (CDC). Asthma attacks among persons with current asthma - United States, 2001-2010. MMWR Surveill Summ. 2013;62 (Suppl 3):93-98. http://www.ncbi.nlm.nih.gov/pubmed/24264497
    View Written By | Review Date
    Written by: Sarah O'Brien | Last Reviewed: May 2016.
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