Asthma emergency first aid

Asthma flare-ups and attacks#

An asthma flare-up is a worsening of asthma symptoms and lung function compared with how you usually feel day to day. A flare-up can come on slowly, over hours, days or even weeks, or very quickly, over minutes. A sudden or severe flare-up is sometimes called an asthma attack.

An asthma attack can quickly become an emergency, but quick action reduces that risk. If you or a family member has asthma, make sure you have an up-to-date asthma action plan from your doctor and that you know asthma first aid. Your doctor will prescribe the correct medication, help you develop a plan to manage your asthma, and give you an action plan with instructions for a flare-up.

When to start asthma first aid#

Follow your asthma action plan as soon as the symptoms of an asthma attack appear. If you do not have a plan, or you are helping someone else, start asthma first aid. Do not wait until the asthma is severe.

Mild to moderate signs#

Start asthma first aid if the person has:

• Minor difficulty breathing
• The ability to talk in full sentences
• The ability to walk or move around

Severe signs#

Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance and start asthma first aid if the person has:

• Obvious difficulty breathing
• An inability to speak a full sentence in one breath
• Tugging of the skin between the ribs or at the base of the neck
• A cough or wheeze

Life-threatening signs#

Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance and start asthma first aid if the person:

• Is gasping for air
• Can only say one or two words per breath
• Is confused or exhausted
• Has lips turning blue
• Is getting worse very quickly
• Is collapsing
• Is getting little or no relief from their reliever inhaler

Asthma first aid steps#

If you are using a blue/gray reliever puffer, the basic steps are:

1. Sit the person upright. Be calm and reassuring, and do not leave them alone.
2. Give 4 separate puffs of the blue/gray reliever. Shake the puffer, put 1 puff into a spacer, and have the person take 4 breaths from the spacer. Repeat until 4 puffs have been given. (If you do not have a spacer, give 1 puff as the person takes 1 slow, deep breath and holds it for as long as is comfortable, then repeat until all puffs are taken.) Remember: shake, 1 puff, 4 breaths.
3. Wait 4 minutes. If there is no improvement, give 4 more separate puffs of the blue/gray reliever in the same way.
4. If breathing does not return to normal, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance. Tell the operator that someone is having an asthma emergency. Keep giving 4 separate puffs, with 4 breaths for each puff, every 4 minutes until emergency help arrives.

Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) immediately if:

• The person is not breathing
• Their asthma suddenly becomes worse, or is not improving
• The person is having an asthma attack and there is no reliever medication available
• You are unsure whether it is asthma

Reliever medications#

One of the most common reliever medications in many countries is salbutamol (albuterol), often known as the “blue puffer”, which is widely available from a pharmacy. If you are not sure whether someone is having an asthma attack, it is still reasonable to give blue reliever medication, because it is unlikely to cause harm.

Not everyone uses the same reliever. Some people use a different blue reliever, terbutaline (Bricanyl), which comes in a different type of inhaler. Others use a “dual-purpose” reliever that contains budesonide and formoterol together, taken as needed; this both relieves symptoms and reduces the risk of serious flare-ups by relaxing tight airway muscles and treating airway inflammation. The same medicine may also be prescribed as a “preventer”, and some people use the same medicine for both their reliever and their preventer.

The first aid steps differ depending on the type of inhaler. Always follow the instructions in your asthma action plan about what to use during a flare-up or attack.

Asthma and anaphylaxis#

People having a severe allergic reaction (anaphylaxis) can also have asthma-like symptoms. If someone with known asthma and an allergy to food, insects or medication has sudden breathing difficulty — including wheeze, persistent cough or a hoarse voice — always give the adrenaline (epinephrine) autoinjector first and then the asthma reliever, even if there are no skin symptoms. If the person has an anaphylaxis action plan, follow it, and call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance.

Thunderstorm asthma#

People who have asthma or hay fever can develop severe asthma symptoms during grass pollen season, when high amounts of grass pollen in the air combine with a certain type of thunderstorm. If you are affected by pollen, talk to your doctor about how to prepare.

Key points#

• Follow your asthma action plan as soon as the symptoms of an asthma attack appear, and do not wait until the asthma is severe.
• The first aid pattern is: sit upright, give 4 puffs of blue/gray reliever, wait 4 minutes, and repeat — call for an ambulance if breathing does not return to normal.
• Salbutamol (albuterol) is a common reliever, but others use terbutaline or a dual-purpose budesonide/formoterol reliever; follow your action plan for which to use.
• If asthma symptoms occur in someone at risk of anaphylaxis, always give the adrenaline autoinjector first, then the reliever.
• Everyone in the community benefits from knowing asthma first aid.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).