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What to do during an emergency asthma attack ? : Part-1

This article explains care and treatment procedures one needs to adopt both during and after an emergency asthma attack. Prompt treatment procedures started quickly at the onset of symptoms itself prevent asthma attack or at least reduce its severity.


Asthma is a lung condition of long-term. Individual who suffers from asthma has very sensitive airways in lungs. These airways very easily react to stimuli or triggers. Reaction causes flare-up which in turn causes muscles surrounding air passages to squeeze tightly. Consequently, airways swell and narrow down as well as there is accumulation of more and more mucus. A person thereby experiences difficulty in breathing. When flare-up is sudden then it is known as an asthma attack. These asthma attacks prove to be fatal if emergency treatments are not made readily available. Each and every individual known to be suffering from asthma should be well prepared for an emergency asthma attack. Regardless of whether asthma is kept under control or is getting worst everyday, beforehand preparations are essential as they can save life during an emergency asthma attack.

Causes of sudden flare-up

Immune system of an individual suffering from asthma is very sensitive. In such cases, even slightest triggers thereby can inflame bronchial tubes. This inflammation of airways is enough to induce an asthma attack. Triggers vary from one individual to another.

Some of the triggers which can induce an asthma attack are-

  • smoke of tobacco,
  • pollen from trees, grasses and flowers,
  • dust mites (small indoor insects not visible to naked eyes),
  • cold air or windy weather,
  • dry air,
  • pets,
  • high levels of stress,
  • air pollution,
  • upper respiratory infections,
  • certain drugs like aspirin, NSAID's, non selective beta-blockers,
  • feathers,
  • animal dander,
  • certain foods and drinks containing sulfites,
  • exercise,
  • gastroesophageal reflux disease,
  • mold thrives inside of home on wet and damp areas like basements, kitchen sinks, bathrooms etc,
  • urine,
  • droppings of cockroaches and pests containing specific proteins,
  • hair sprays,
  • home decor products etc

Symptoms experienced

  • Difficulty in breathing,
  • Wheezing sound both during inhalation and exhalation,
  • Increased cough,
  • Tightness or pain experienced in chest,
  • If a patient uses a peak flow meter then readings show low peak expiratory flow during an asthma attack,
  • Rescue inhalers do not showing improvements,
  • Difficulty in sleeping, eating or speaking etc.

What to do during an asthma attack ?

  • Maintain calm -
    It is very essential not to panic when asthma attack occurs. This will only worsen the situation. One has to calmly and patiently deal with the whole scenario. If you are trying to help others suffering from an emergency asthma attack then reassure them that you are there to take care of them. Panic will shallow breathing which is definitely not good for asthma attack. If one maintains calm then can very easily deal with this stressful situation.
  • Sit upright -
    Asthma attack is caused due to squeezing of air ways. Thus, sitting in an upright position will facilitate ease in breathing and affected person will be able to breathe as much unobstructed as possible. During asthma attack, it is never advisable to lie down cause it may worsen the situation. Thus, sitting in an upright position and taking slow, steady breaths can show some improvement in the condition. Loosen tight clothing.
  • Get rid of triggers -
    Asthma attacks usually occur in response to some triggering stimulus. There are number of triggering factors which can induce an asthma attack all of a sudden. Some of them are pollen, smoke, dirt, dust, cold weather, wind, feathers, intense exercises etc. Move away from triggers as quick as possible or else eliminate them. This will bring some relief in asthma.
  • Follow emergency treatment plan -
    Asthmatic individuals should always carry their emergency kit along with them, wherever they go. This kit carries rescue inhalers, bronchodilators, anti-inflammatory drugs etc. Use them quickly and correctly as prescribed by the doctor. Take two to six puffs of rescue inhalers. If inhalers are difficult to use then make use of nebulizer if it is available. Repeat the treatment after some time if necessary. These inhalers contain quick-acting drugs which goes deep into the lungs and provide some instant relief. Use spacer for better results. In between every puff, there should be a gap of 30-60 seconds. At most 10 puffs can be taken. Usually inhalers contain inhaled short-acting beta 2-agonists.
  • Make a call for medical help -
    Sometimes asthma attack is so severe that it may not subside even after removal of triggers and properly following of emergency treatment plan. In such cases emergency medical treatment becomes essential. If one is experiencing difficulty in breathing then call an ambulance or concerned doctor immediately. Even if symptoms have disappeared, make sure to call doctor so that he can prescribe some additional treatment or make some changes in the existing one. Doctor will ask to continue using quick-acting inhalers every 3 to 4 hours for next couple of days along with oral corticosteroid drugs. If one is not carrying emergency asthma kit and has suffered from an asthma attack then one do make a call for medical help as soon as possible. If one is carrying inhaler then take puff (maximum 10) till medial help arrives.

What to do after an asthma attack ?

If asthma attack gets relieved without the help of any emergency hospital support then consult concerned doctor within 24 hours. In case of hospital support, see doctor again within 48 hours after getting discharged. Consultation is important because if proper treatment is not followed then another emergency asthma attack may occur. It is important to make necessary changes which will prevent future attacks. One must know how to use inhalers properly. Following the whole treatment plan as prescribed by doctor will effectively reduce risk of any asthma attack in the future. Discuss everything with doctor and always carry asthma related medicines every time and every where.

Following preventive measures can reduce risk of future emergency asthma attacks-

  • Follow asthma action plan properly and carry all the medicines prescribed by concerned doctor everywhere as a precautionary measure i.e., if medicines are carried then in case of an emergency can immediately relieve attack as soon as triggers cause flare-up. This will prevent asthma attack. Be familiar with all the medicines prescribed. Learn how to use inhalers properly. Family members, friends, colleagues and others who stay close in touch with an asthmatic patient should also be aware of all the prescribed medicines and correct usage of inhalers cause they can be of real help in case of emergencies.
  • Go for regular checkup and inform concerned doctor about most recent asthma attacks and other asthma related issues.
  • If symptoms get worst then never hesitate to make an emergency call to the doctor. If inhalers are not providing any relief in-spite of been used again and again then make an urgent appointment.
  • Get rid of triggers. Try to eliminate them as much as possible. If triggers are difficult to identify then take an allergy test for the same.
  • To avoid an asthma attack, make sure asthma is kept under control. Asthma attacks only occur when an asthmatic individual fails to follow prescribed treatment plan, do not regularly pay follow up visit to doctor, runs out of medicines, does not carry emergency back up drugs etc. If all these things are taken care of then an asthma attack can be very well avoided.
  • Lose extra kilos from the body. Follow a weight loss plan prescribed by the doctor. Do not go for abrupt weight loss i.e., it should be at a healthy level.
  • Do not smoke as smoke can exaggerate asthma leading to an attack. Even avoid company of others when they smoke.
  • Avoid getting exposed to air pollution or allergens. Wear a mask to avoid an attack.
  • Do not allow respiratory infections to make a room in the body. When exercising in cold weather, always wear a face mask. Regularly take flu related vaccinations.

Untreated asthma attack

If an asthma attack is left untreated without making use of emergency asthma drugs and other treatments then wheezing sound experienced by patient becomes quite loud and difficulty in breathing increases. Initially at the onset of attack, patient may be able to record peak flow meter readings and readings will definitely be less than the ones recorded in absence of an attack. But as time progresses, patient may find extremely difficult to record the same. This is because of tightening of chest experienced. Soon silent chest is experienced which is quite a dangerous sign. It is so called because wheezing sound stops due to tightening of lungs and lungs get tightened to such an extent that air movement ceases wheezing. Some patients feel that since wheezing has stopped, it means their asthma attack is getting relieved, but that is not true. If other symptoms still continue but just wheezing sound disappears mean it is a sign of danger. Patient may lose his ability to speak and develop cyanosis i,e., blue color around lips due to less amount of oxygen in blood. If treatment is not provided then patient may collapse and die.


Anyone suffering from an asthma should be ready to face an attack or an emergency crisis even in presence of proper daily treatment and care. This is because one cannot avoid triggers completely. Sometimes, one may not even realize it and symptoms may start getting worst. An attack may take anywhere from a few minutes to couple of hours to a few days to develop. It affects people belonging to all age groups. Anyone suffering from an asthma should always carry an asthma emergency kit with them and should properly follow asthma care plan. In this way, one can prevent worsening of symptoms and severity of asthma attack. To know more about asthma attack needing medical support, read What to do during an emergency asthma attack: Part-2 which explains various emergency medical procedures.

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