What to do during an asthma attack

An asthma attack occurs when you come into contact with an asthma trigger. This causes your lungs to become inflamed and symptoms to occur.

This causes breathing difficulties and asthma attack symptoms.

Asthma attack triggers

Certain stimuli can cause your immune system to overreact, which is a risk factor for asthma attacks.

Everyone’s triggers are different, but some of the most common asthma triggers include:

• allergies (e.g. pollen, dust or pet fur)
• air pollution
• sudden weather changes
• cigarette smoke
• exercise
• cold & flu

Knowing what triggers your asthma is important when it comes to treating your asthma and preventing asthma attacks.

The first signs and symptoms of an asthma attack include:

• your symptoms are getting worse (e.g. you’re coughing or wheezing more, you feel more breathless and your chest feels tight)
• your reliever inhaler is not helping your symptoms
• you’re too breathless to speak, eat or sleep

You might not experience symptoms suddenly. In some cases, it might take a few hours or days before an asthma attack occurs.

When should I seek medical help?

You should call emergency services if your reliever inhaler does not improve your symptoms, or you feel your symptoms getting worse.

You should act quickly as asthma attacks can be fatal. According to the World Health Organisation (WHO) Trusted source World Health Organization (WHO) Government Source International Public Health Information Go to source , asthma caused over 450,000 deaths worldwide in 2019.

If you think you’re having an asthma attack, you should follow these 5 steps.

How to manage an asthma attack
1		Sit up straight and try to stay calm
2		Take one puff of your reliever inhaler every 30-60 seconds. Take up to 10 puffs.
3		Call emergency services and repeat step 2 if you don’t feel better.
4		Repeat step 2 if the ambulance hasn’t arrived after 10 minutes.
5		Call again if your symptoms still aren’t better after repeating step 2.

You should try to take details of your medications or your asthma action plan with you if you go to the hospital.

This is not the right advice if you are on SMART or MART treatment. Ask your GP or asthma nurse for advice on what to do if you are on either treatment.

You should always carry your reliever inhaler. But, mistakes happen.

If you have an asthma attack with no inhaler you should:

1. Move away from the environment - if something has triggered your asthma and you can do so.
2. Sit upright - this will help to keep your airways open and make breathing easier.
3. Take slow, deep breaths - this will help to control your symptoms.
4. Stay calm - panicking may make your symptoms worse. You may want to close your eyes and visualise a peaceful place while you breathe to reduce anxiety.
5. Get emergency medical help - if nothing helps, call the emergency helpline number in your area to get rapid medical treatment.

Seek medical attention if self-help measures don’t help.

You can read our full guide on what to do during an asthma attack with no inhaler by clicking above.

After an asthma attack, you should book an appointment with your GP or asthma nurse as soon as possible. Not only does it reduce the risk of another asthma attack but it also helps you recover.

Asthma and Lung UK recommend you book an urgent same-day appointment if you have had an asthma attack at home. If you went to the hospital or had to use a ‘rescue pack’ of steroids, you should book an urgent appointment within 2 working days.

They may need to change your treatment plan if it’s not properly managing your asthma. They can also prescribe a short course of steroid tablets to help reduce any swelling and inflammation after the asthma attack.

They will also review your asthma action plan and update anything that might have changed such as a new trigger.

Asthma attacks only occur in people with asthma. If you think you’re having an asthma attack but have not been diagnosed with asthma, seek medical attention.

However, some conditions may present asthma-like symptoms.

Panic attacks

Panic attacks are a symptom of certain anxiety disorders. It is an exaggerated body response to fear.

It can cause chest pain or breathing difficulties, as well as symptoms such as:

• a pounding or racing heartbeat
• feeling faint, dizzy or light-headed
• feeling very hot or very cold
• feeling or being sick
• sweating, trembling or shaking

Physical symptoms can come on very quickly. If you feel like you’re having a panic attack, you should focus on your breathing. Some people find focusing on their senses (e.g. by chewing gum or cuddling something soft) helps calm them down.

If you regularly struggle with panic attacks, you should speak to your doctor for long-term treatment options or therapy.

Acid reflux

A common and less serious cause of asthma-like symptoms is acid reflux or gastro-oesophageal reflux disease (GORD).

This condition is caused by stomach acid coming up into the oesophagus. It causes heartburn, a pain in the upper chest which may feel like chest tightness. It can also also cause a cough.

Occasionally acid reflux goes away on its own or with lifestyle changes. If you experience symptoms often, you may need treatment.

Lung conditions

If you don’t have asthma, another lung condition may be causing sudden breathing problems.

• chest infection - a viral or bacterial infection that causes a chesty cough, wheezing, chest pain and flu-like symptoms (e.g. fever and muscle aches).
• chronic obstructive pulmonary disease (COPD) - a group of lung conditions that cause shortness of breath, a persistent cough, frequent chest infections and wheezing.
• bronchiectasis - a long-term condition that causes a persistent cough and shortness of breath caused by damage to the airways.
• lung cancer - causes a persistent cough, coughing up blood, persistent breathlessness, pain while coughing, unexplained tiredness, and weight loss.

If you have a new and persistent cough, you should see your doctor as soon as possible. While it’s rarely serious, it’s good to check your symptoms.

Heart conditions

Another potential cause of chest tightness and breathlessness is a heart problem.

One possibility is congestive heart failure. This can be a chronic or acute condition in which your heart cannot pump blood around the body properly and can sometimes cause fluid to build up in the lungs.

Another possibility is coronary heart disease. This condition is caused by a fatty substance called cholesterol building up in the arteries and limiting blood flow to the heart. It can cause difficulty breathing, chest pain (angina), pain and nausea.

A more serious possibility is a heart attack. This is where the blood supply to the heart is suddenly blocked. This causes symptoms including:

• chest pain, pressure or heaviness
• pain that spreads to your arm, jaw, neck or stomach
• feeling lightheaded or dizzy
• sweating
• feeling sick and/or being sick
• overwhelming feeling of anxiety
• coughing or wheezing

Sometimes, the chest pain is mild and confused for indigestion. If you think you’re having a heart attack, you should call emergency services as soon as possible.

The best way to prevent an asthma attack is to take your asthma treatments correctly. This involves taking your preventer inhaler daily and carrying your reliever inhaler with you at all times.

You should also avoid your asthma triggers. For example, if you know that cold weather causes symptoms, you should wrap up warm.

Your asthma healthcare team may suggest having an asthma action plan. This is a plan you complete with your GP or asthma nurse that details your medications, triggers and what to do if you have an asthma attack.