Asthma – first aid

What to do if someone's having an asthma attack

Key points about asthma first aid

  • An asthma attack is an emergency – act fast.
  • Anyone with asthma can have a severe asthma attack.
  • Worsening asthma symptoms include being short of breath, wheezy, have tightness in your chest and you may also cough.
  • Symptoms can get worse quickly so it's important to act fast. 
  • If you have an asthma action plan follow the instructions there.
Young woman outdoors experiences pain in chest when coughing

An asthma attack is when your airways swell and narrow making you wheeze, possibly cough and find it difficult to breathe. 

Diagram of labelled respiratory system and normal and asthmatic airways

Image credit: Depositphotos

Note: The information on this page is for adults. See KidsHealth, NZ for information about asthma attacks in children(external link).


An asthma attack may be mild, moderate or severe

  • Anyone with asthma can have a severe asthma attack. 
  • An asthma attack can take anything from a few minutes to a few days to develop.
  • Symptoms may be mild or moderate and can quickly get worse so it's important to act fast.
  • If you have an asthma action plan follow the instructions on there.

Mild asthma symptoms

Early signs that asthma may be getting worse can include mild cough, slight wheeze or coughing or wheezing when exercising or excited.

Moderate asthma symptoms

When asthma becomes more serious, symptoms may include:

  • cough or wheeze are getting worse
  • difficulty breathing
  • difficulty talking; you can't complete a sentence without needing a few breaths.

Severe symptoms – call 111 if:

  • you have worsening wheezing, cough, chest tightness
  • you can't speak a full sentence in 1 breath
  • you're breathless and have to put extra effort into breathing
  • your nostrils are flaring with each breath
  • the skin at your ribs, neck or throat sucks in with each breath
  • your peak flow reading's getting worse (if checked)
  • you've used a reliever inhaler but there's no improvement in your symptoms.

If someone is having an asthma attack, follow the ASTHMA acronym

A = Assess

Assess whether the person's asthma attack is mild, moderate or severe.

If the person has severe asthma or is frightened, call an ambulance on 111.

 

S = Sit

Sit the person upright and stay with them. Reassure them calmly.

 

T = Treat (with a reliever inhaler)

It's important to carry your reliever inhaler with you at all times.

  • Symbicort or DuoResp Spiromax: Use 1 puff initially and repeat if needed, up to 12 puffs daily. These inhalers quickly reduce inflammation of your airways and help you to breathe more easily.
  • Ventolin or SalAir: Always use a spacer with these inhalers. Inhale 1 puff through the spacer and take 6 breaths per puff through the spacer. Use 1 puff initially and repeat if needed, up to 6 puffs. For severe symptoms, use 6 puffs through the spacer, every 6 minutes until help arrives. Make sure to take 6 slow breaths for each puff.
  • Bricanyl: Use 1 puff initially and repeat if needed, up to 6 puffs.

     


H = Help

If the person is not improving, call an ambulance immediately on 111. Continue to use the reliever inhaler every few minutes until help arrives. 

 

M = Monitor

  • If the person is improving, keep monitoring them for signs of improvement or worsening of symptoms. If necessary, repeat doses of the reliever inhaler.
  • If the person is not improving, continue to use the reliever inhaler every few minutes until help arrives. 


A = All OK!

When the person is free of wheeze, cough or breathlessness, they can return to quiet activity.

Ensure a preventer inhaler is part of your asthma management plan. This is important to reduce the chance of this type of attack happening. This may mean a separate preventer inhaler is needed or a combined reliever and preventer inhaler, if you don't have this already.

Ensure an asthma action plan is written up to guide you through asthma attacks in the future. Regular peak flow monitoring may be useful to reduce the chance of further asthma attacks. Read more about peak flow monitoring.

If symptoms come back, repeat the treatment and rest. It's important to always see your healthcare provider as soon as possible after an asthma attack.


Video: How to use a spacer

(Asthma New Zealand, NZ, 2022)

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

Last reviewed: