Treating an Asthma Attack – Rescue Medications

When asthma symptoms start suddenly and get progressively worse, you could be having an asthma attack.1 The symptoms may include wheezing, coughing, shortness of breath, and chest tightness, or any combination of these. Your peak flow will go down. Allergens, irritants, or viral infections are common triggers for an asthma attack.2 Asthma symptoms can also start slowly and get progressively worse over a few days. Other terms for asthma attack are “flare up,” “exacerbation,” and “episode.”2

Treating an asthma attack

A change in treatment is necessary to treat an asthma attack.2 Your provider should give you a written Asthma Action Plan, which describes what to do in the event of an asthma flare-up. Your plan should say who and when to call, based on your peak flow measurements and the type of symptoms you are having.

For the most part, treatment for an asthma attack begins at home.1 By starting treatment early, you might be able to prevent a severe attack. Everyone with asthma should have a rescue inhaler.1 Rescue inhalers contain a short-acting beta agonist medication. This medication opens your airways quickly. Your daily control medications do not work fast enough to treat an attack.

Your provider will tell you how many puffs of your rescue inhaler to take at the start of an asthma attack.1 Use a spacer or nebulizer to make sure the medication gets to your lungs.3 The next step depends on whether your symptoms get better after taking your rescue inhaler.1

  • Good response: Your symptoms improve. Your peak flow is 80% or higher. Call your health care provider for any additional instructions.
  • Incomplete response: You continue to have symptoms. Your peak flow is 50% to 79%. Continue taking your rescue inhaler. Call your provider that day to see if you need additional medications.
  • Poor response: Your symptoms do not improve. Your peak flow is less than 50%. Continue taking your rescue inhaler. Call your provider immediately and head to the emergency department.

People at high risk of a severe or fatal asthma attack should seek medical help immediately after starting treatment at home.1

Short-acting beta agonists

Short-acting beta agonists are the main treatment for asthma attacks.1 They are also used before exercise to prevent exercise-induced asthma. These medications cause the muscles around the airways to relax. They work within three to five minutes. Short-acting beta agonist is abbreviated SABA.

Which medications are SABAs?

Currently, there are two SABAs (Table).1 They are equally safe and effective.4 There are several brand name products that contain albuterol.

Table. Short-acting beta agonists

Brand Name
Generic Name
Proair, Proventil, Ventolin, Accuneb
Albuterol
Xopenex
Levalbuterol

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

When are SABAs prescribed?

SABAs may be the only treatment needed by patients with intermittent asthma.1 For these people, the SABA should only be used when needed for relief of symptoms.

Everyone with persistent asthma should have a SABA for quick relief of symptoms.1 If you are using your SABA more than twice a week, talk to your provider. This is a sign that your asthma is not well controlled. You may need to change your long-term control medications.

SABAs are also used to treat exercise-induced asthma.5 They should be taken five to 20 minutes before starting to exercise to open up the airways. They are effective for two to four hours.

What are the risks of taking SABAs?

You may feel shaky, anxious, or restless after taking a SABA.6 They can cause headache. If you feel your heart beating quickly or irregularly, call your health care provider.

Regular or frequent use of SABAs is not recommended, because it is a sign of poor asthma control.1

Ipratropium (Atrovent)

Ipratropium (brand name: Atrovent) is an inhaled medication. It has not been approved by the US Food and Drug Administration for the treatment of asthma. It is approved to treat chronic obstructive pulmonary disease (COPD).7 However, the National Heart, Lung, and Blood Institute has stated that it can help patients with moderate to severe asthma attacks.1 It may be used in the emergency department along with SABAs.

Oral corticosteroids

Oral corticosteroids reduce inflammation. These medications include methylprednisolone, prednisolone, and prednisone.1 They may be used short-term at the start of an asthma attack.1 This may lead to a shorter attack and less risk of being hospitalized. They can be prescribe ahead of time for you to take at home. Ask your health care provider before starting oral corticosteroids. They can also be given in the emergency department.

Oral corticosteroids may also be taken after an asthma attack. A typical course is three to ten days.1 People who are hospitalized for asthma have fewer asthma symptoms, less risk of re-hospitalization, and use less SABAs if they take oral corticosteroids.4

Oral corticosteroids can cause a number of side effects. The side effects of long-term use can be serious. The short-term side effects generally get better once you stop the medication. Short-term side effects include:1

  • Changes in blood sugar
  • Increased appetite
  • Fluid retention
  • Weight gain
  • Mood changes
  • High blood pressure
  • Stomach ulcers
  • Necrosis (rare)

IV medications (corticosteroids and magnesium)

If you are treated at the hospital for an asthma attack, you may be given IV (intravenous) medications. IV corticosteroids may be given in the emergency department to reduce your risk of needing hospitalization.4 IV and oral corticosteroids are equally effective.1 IV magnesium is used for life-threatening attacks when other treatments have not worked.1

Written by: Sarah O'Brien | Last Reviewed: May 2016.
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