Overview

During an asthma attack, also called an asthma exacerbation, the airways become swollen and inflamed. The muscles around the airways contract and the airways produce extra mucus, causing the breathing (bronchial) tubes to narrow.

During an attack, you may cough, wheeze and have trouble breathing. Symptoms of a minor asthma attack get better with prompt home treatment. A severe asthma attack that doesn't improve with home treatment can become a life-threatening emergency.

The key to stopping an asthma attack is recognizing and treating an asthma flare-up early. Follow the treatment plan you worked out with your doctor ahead of time. Your treatment plan should include what to do when your asthma starts getting worse, and how to deal with an asthma attack in progress.

Symptoms

Asthma attack signs and symptoms include:

• Severe shortness of breath, chest tightness or pain, and coughing or wheezing
• Low peak expiratory flow (PEF) readings, if you use a peak flow meter
• Symptoms that fail to respond to use of a quick-acting (rescue) inhaler

Signs and symptoms of an asthma attack vary from person to person. Work with your doctor to identify your particular signs and symptoms of worsening asthma — and what to do when they occur.

If your asthma symptoms don't improve or get worse after you take medication as your doctor directed, you may need emergency treatment. Your doctor can help you learn to recognize an asthma emergency so that you'll know when to get help.

When to see a doctor

If your asthma flares up, immediately follow the treatment steps you and your doctor worked out in your written asthma plan. If your symptoms and peak expiratory flow (PEF) readings improve, home treatment may be all that's needed. If your symptoms don't improve with home treatment, you may need to seek emergency care.

When your asthma symptoms flare up, follow your written asthma plan's instructions for using your quick-acting (rescue) inhaler. PEF readings ranging from 51% to 79% of your personal best are a sign you need to use the quick-acting (rescue) medications prescribed by your doctor.

Check asthma control steps with your doctor

Asthma can change over time, so you'll need periodic adjustments to your treatment plan to keep daily symptoms under control. If your asthma isn't well controlled, you're more likely to have an asthma attack. Lingering lung inflammation means your asthma could flare up at any time.

Go to all scheduled doctor's appointments. If you have regular asthma flare-ups, or if you have low peak flow readings or other signs your asthma isn't well controlled, make an appointment to see your doctor.

When to seek emergency medical treatment

Seek medical attention right away if you have signs or symptoms of a serious asthma attack, which include:

• Severe breathlessness or wheezing, especially at night or in the early morning
• The inability to speak more than short phrases due to shortness of breath
• Having to strain your chest muscles to breathe
• Low peak flow readings when you use a peak flow meter
• No improvement after using a quick-acting (rescue) inhaler

Causes

An overly sensitive immune system makes your airways (bronchial tubes) become inflamed and swollen when you're exposed to certain triggers. Asthma triggers vary from person to person. Common asthma attack triggers include:

• Pollen, pets, mold and dust mites
• Upper respiratory infections
• Tobacco smoke
• Inhaling cold, dry air
• Gastroesophageal reflux disease (GERD)
• Stress

For many people, asthma symptoms get worse with respiratory infections, such as those caused by the common cold. Some people have asthma flare-ups caused by something in their work environment. Sometimes, there isn't an apparent cause for an asthma attack.

Risk factors

Anyone who has asthma is at risk of an asthma attack. You may be at increased risk of a serious asthma attack if:

• You've had a severe asthma attack in the past
• You've previously been admitted to the hospital or had to go to the emergency room for asthma
• You've previously required intubation for an asthma attack
• You use more than two quick-acting (rescue) inhalers a month
• Your asthma attacks tend to sneak up on you before you notice symptoms have worsened
• You have other chronic health conditions, such as sinusitis or nasal polyps, or cardiovascular or chronic lung disease

Complications

Asthma attacks can be serious. They can:

• Interrupt everyday activities such as sleep, school, work and exercise, causing a significant impact on your quality of life — and can disrupt the lives of those around you.
• Send you to the emergency room, which can be stressful and costly.
• Lead to respiratory arrest and death.

Prevention

The best way to avoid an asthma attack is to make sure your asthma is well controlled in the first place. This means following a written asthma plan to track symptoms and adjust your medication.

While you may not be able to eliminate your risk of an asthma attack, you're less likely to have one if your current treatment keeps your asthma under control. Take your inhaled medications as prescribed in your written asthma plan.

These preventive medications treat the airway inflammation that causes asthma signs and symptoms. Taken on a daily basis, these medications can reduce or eliminate asthma flare-ups — and your need to use a quick-acting inhaler.

See your doctor if you're following your asthma action plan but still have frequent or bothersome symptoms or low peak flow readings. These are signs your asthma isn't well controlled, and you need to work with your doctor to change your treatment.

If your asthma symptoms flare up when you have a cold or the flu, take steps to avoid an asthma attack by watching your lung function and symptoms and adjusting your treatment as needed. Be sure to reduce exposure to your allergy triggers, and wear a face mask when exercising in cold weather.

Diagnosis

For adults and children over 5 years old, lung (pulmonary) function tests are used to check how well the lungs are working. Poor lung function is a sign that your asthma isn't well controlled. In some cases, lung function tests are also used in asthma emergencies to help your doctor understand the severity of an asthma attack or how well treatment is working.

Lung function tests include:

• Peak flow. Your doctor may take a peak flow reading when you come in for a scheduled visit or for emergency treatment during an asthma attack. This test measures how quickly you can breathe out. You may also use a peak flow meter at home to monitor your lung function.

  The results of this test are known as peak expiratory flow (PEF). A peak flow test is done by blowing into a mouthpiece as hard and as fast as you can with a single breath (expiration).

• Spirometry. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. A common spirometry measurement is forced expiratory volume, which measures how much air you can breathe out in one second.

  The results of this test are known as forced expiratory volume (FEV). Spirometry can also measure how much air your lungs can hold and the rate at which you can inhale and exhale.

• Nitric oxide measurement. This exam measures the amount of nitric oxide gas you have in your breath when you exhale. High nitric oxide readings indicate inflammation of the bronchial tubes.
• Pulse oximetry. This test measures the amount of oxygen in your blood. It's measured through your fingernail and only takes seconds.

Treatment

If you and your doctor have worked out an asthma plan, follow its directions at the first sign of an asthma attack.

This generally means taking two to six puffs of a quick-acting (rescue) inhaler to get airway-expanding medication, such as albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, others) and levalbuterol (Xopenex), deep into your lungs. Small children and those who have trouble with inhalers can use a nebulizer. After 20 minutes, you can repeat the treatment one time if necessary. If you continue to wheeze or feel breathless after treatment, visit your doctor or urgent care that day.

If you're having symptoms of a severe asthma attack, such as difficulty speaking because you're so short of breath, use your quick-acting (rescue) medication and get to a doctor's office or urgent care immediately.

Your doctor may recommend that you continue to use quick-acting medication every three to four hours for a day or two after the attack. You might also need to take oral corticosteroid medication for a short time.

Emergency treatment

If you go to the emergency room for an asthma attack in progress, you'll need medications to get your asthma under immediate control. These can include:

• Short-acting beta agonists, such as albuterol. These are the same medications as those in your quick-acting (rescue) inhaler. You may need to use a machine called a nebulizer, which turns the medication into a mist that can be inhaled deep into your lungs.
• Oral corticosteroids. Taken in pill form, these medications help reduce lung inflammation and get your asthma symptoms under control. Corticosteroids can also be given intravenously, typically to patients who are vomiting or who are experiencing respiratory failure.
• Ipratropium (Atrovent HFA). Ipratropium is sometimes used as a bronchodilator to treat a severe asthma attack, especially if albuterol is not fully effective.
• Intubation, mechanical ventilation and oxygen. If your asthma attack is life-threatening, your doctor may put a breathing tube down your throat into your upper airway. Using a machine that pumps oxygen into your lungs will help you breathe while your doctor gives you medications to bring your asthma under control.

After your asthma symptoms improve, your doctor may want you to stay in the emergency room for a few hours or longer to make sure you don't have another asthma attack. When your doctor feels your asthma is sufficiently under control, you'll be able to go home. Your doctor will give you instructions on what to do if you have another attack.

If your asthma symptoms don't improve after emergency treatment, your doctor may admit you to the hospital and give you medications every hour or every few hours. If you're having severe asthma symptoms, you may need to breathe oxygen through a mask. In some cases, a severe, persistent asthma attack requires a stay in the intensive care unit (ICU).

Lifestyle and home remedies

All asthma attacks require treatment with a quick-acting (rescue) inhaler such as albuterol. One of the key steps in preventing an asthma attack is to avoid your triggers.

• If your asthma attacks seem to be set off by outside triggers, your doctor can help you learn how to minimize your exposure to them. Allergy tests can help identify any allergic triggers.
• Washing your hands frequently can help reduce your risk of catching a cold virus.
• If your asthma flares up when you exercise in the cold, it may help to cover your face with a mask or scarf until you get warmed up.

Preparing for an appointment

Be prepared for your visit to your doctor so that you can get the most out of your appointment. At each visit:

• Take your asthma action plan with you. If you haven't made one yet, work with your doctor to create one. This plan should discuss how to treat an asthma attack.
• Bring your peak flow meter results and all of your medications.
• Be prepared to discuss your symptoms, and how much your asthma has been bothering you. Often, periodic changes in treatment are needed to keep asthma under control and to prevent asthma attacks.
• Be prepared to demonstrate using your metered-dose inhaler. Improper use can reduce an inhaler's effectiveness.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. Some good questions to ask your doctor include:

• Do my medications or treatment plan need to be changed?
• What are the signs that I may be about to have an asthma attack?
• What can I take to prevent an asthma attack when my symptoms get worse, or when I'm exposed to my triggers?
• What steps do I need to take to stop an asthma attack in progress?
• When do I need to go to the emergency room or seek other emergency treatment?
• I'm having more heartburn. What can I do to prevent this?
• Is it time for my flu shot? Am I due for a pneumonia shot?
• What else can I do to protect my health during cold and flu season?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• Have you noticed anything that makes your asthma worse?
• What medications are you taking?
• How and when are you taking them?
• Can you show me how you use your inhaled medication?
• Are you having any problems with your medications?
• Do you know when to call me or go to the hospital?
• Do you have any questions about your asthma action plan?
• Are you having any problems with your asthma action plan?
• Is there anything you want to be able to do that you can't because of your asthma?