Asthma Attack (Exacerbation)

Overview

An asthma attack, also called an asthma exacerbation, is a sudden worsening of asthma symptoms. During an attack, the airways in your lungs become swollen, tighten up, and produce extra mucus. This makes it very hard to breathe. Asthma is a long-term condition, but attacks can happen when something triggers your airways. Most attacks can be treated, but severe ones are medical emergencies.

Asthma is very common. In the UK, about 5.4 million people have asthma, and many experience flare-ups from time to time.

Asthma can affect anyone, but it often starts in childhood. However, adults can develop asthma too. It affects people of all ages, though symptoms may change over a lifetime.

Symptoms

Common symptoms

• Feeling very short of breath or winded, like you can't get enough air in or out.
• A tight feeling in the chest, as if a band is squeezing you.
• Wheezing – a high-pitched whistling sound when you breathe out.
• Coughing, especially at night or early morning, that won't stop.
• Breathing faster than normal, or feeling you need to sit up to breathe easier.
• Trouble speaking in full sentences because you're so breathless.

Symptoms in children

• In young children, watch for fast breathing, the skin between the ribs or above the collarbone sucking in with each breath, flared nostrils, or a cough that won't let them sleep. They may also seem anxious or quieter than usual.

Causes

Main causes

• Viral infections, such as a cold or the flu.
• Allergens like pollen, dust mites, pet dander, or mould.
• Irritants in the air: smoke (including tobacco and bushfire smoke), strong perfumes, chemical fumes, or air pollution.
• Weather changes – cold air, sudden temperature drops, or thunderstorms.
• Exercise, especially in cold, dry air.
• Strong emotions such as stress, anxiety, or even laughing very hard.
• Some medicines – always tell any doctor or pharmacist you have asthma.

Risk factors

• Not taking preventer medicine as prescribed, so your airways are already inflamed.
• Not having an updated asthma action plan.
• Exposure to your known triggers, especially in large amounts.
• Having had a severe asthma attack in the past, which puts you at higher risk of another.
• Being overweight or smoking (or breathing second-hand smoke).

When to see a doctor

See a doctor urgently if:

• If you are using your reliever inhaler more often than your action plan allows, or you're worried about your breathing.
• If you've had an attack that required emergency treatment, follow up with your GP or asthma nurse within 48 hours.

Book a routine appointment if:

• For regular asthma reviews – at least once a year – to check your lung function and adjust your treatment plan.
• If you feel your usual medicines aren't controlling your symptoms as well as they used to.
• Before starting a new exercise routine or becoming pregnant, to update your plan.

Diagnosis

If you're already diagnosed with asthma, an attack is usually recognised by your symptoms and response to your reliever. If you've never been diagnosed before and are having breathing problems, a doctor will ask about your symptoms, do a physical exam, and run some tests.

Tests that may be done

• Peak flow measurement: you blow hard into a handheld device to see how quickly air comes out. A low reading can indicate an attack.
• Spirometry: a more detailed lung function test done in a clinic. It measures how much and how fast you can breathe out.
• Pulse oximetry: a small clip on your finger measures the oxygen level in your blood.
• Chest X-ray: sometimes used if the doctor needs to rule out other causes like a lung infection.

What to expect at your appointment

During an attack, the healthcare team will work quickly to help you breathe easier. They'll ask you questions, examine you, and give you treatment right away. They will be calm and reassuring. After you recover, they'll review your asthma action plan to prevent future attacks.

Treatment

Treatment aims to open your airways and reduce inflammation quickly. There are two main parts: quick-relief (reliever) medicines for immediate symptoms, and long-term control (preventer) medicines to keep your airways calm day to day. During an attack, the focus is on quick relief and, if severe, urgent medical help.

Self-care at home

• Follow your asthma action plan. If you don't have one, work with your doctor or nurse to create a written plan.
• Sit upright, not lying down, and try to stay calm – anxiety can make breathing feel worse.
• Take your reliever inhaler as directed. Usually, this is 1–2 puffs into a spacer, with slow deep breaths. You may need to repeat every 30–60 seconds.
• If your reliever doesn't help within a few minutes, or you need it again very soon, call for emergency help.
• Loosen tight clothing around your neck and chest.
• If you have a spacer, use it – it helps the medicine get into your lungs better.

Medical treatments

In a medical setting, treatment may include higher doses of reliever medicine given through a nebuliser (a machine that turns liquid medicine into a fine mist you breathe in), and systemic steroids (anti-inflammatory medicines) to reduce swelling in the airways. In severe attacks, oxygen therapy and other treatments may be needed. The exact approach depends on the severity of the attack and your medical history. Always, the goal is to prevent the attack from getting worse and to get your breathing back to normal.

Living with this condition

Living with asthma means being aware of your triggers and taking your preventer medicine regularly, even when you feel well. It's like wearing a seatbelt every time you drive – it's a habit that protects you. You can still live a full, active life. Many people with asthma exercise, travel, and work normally by keeping their condition under good control.

Lifestyle tips

• Know your triggers and avoid them where possible – e.g., use allergy-proof bedding if dust mites are a problem.
• Don't smoke, and avoid second-hand smoke.
• Keep your home well-ventilated and control humidity to reduce mould and dust mites.
• Exercise regularly, but warm up first and carry your reliever. Swimming in a warm, humid pool can be good.
• Practice relaxation techniques like deep breathing or mindfulness to manage stress.
• Get the annual flu jab and consider the pneumonia vaccine if recommended by your doctor.

Diet and exercise

No specific diet cures asthma, but a balanced diet rich in fruits and vegetables supports lung health. Some people find that foods containing sulfites (like wine, dried fruit) can trigger symptoms. Regular physical activity strengthens your breathing muscles; just choose activities that suit you and always have your reliever available.

Mental health and emotional wellbeing

Having a condition that can suddenly make it hard to breathe can be frightening. It's normal to feel anxious or worried about having another attack. But constant worry can lower your quality of life. If you feel your anxiety is spiralling or you're avoiding things because of fear, talk to your GP. They can help you access counselling or support groups. Remember, you are not alone, and feeling mentally well is part of staying physically well with asthma. If you ever feel like you can't cope or have thoughts of harming yourself, please reach out to a crisis support service such as Befrienders Worldwide (visit befrienders.org to find a helpline in your country) or call your local emergency number.

Prevention

While you can't always prevent an asthma attack, you can greatly reduce your risk. The best prevention is using your preventer inhaler every day as prescribed, even when you feel fine. This builds up protection in your airways. Also, avoid your triggers, treat allergies, and manage any other health conditions like acid reflux or sinusitis that can worsen asthma.

Vaccines

Vaccines against flu (influenza) and pneumonia are important. Respiratory infections are a common trigger for severe asthma attacks, so getting recommended vaccines helps protect you.

Complications

If left untreated

• Severe oxygen deprivation: if an asthma attack isn't treated, oxygen levels in the blood can drop dangerously, which can damage organs.
• Respiratory failure: in extreme cases, the lungs can stop working effectively, requiring mechanical ventilation.
• Status asthmaticus: a prolonged, severe attack that doesn't respond to usual treatment – this is a life-threatening emergency.
• Repeated attacks can lead to permanent changes in the lungs (airway remodelling), making breathing progressively harder over time.

Long-term outlook

The outlook for people with asthma is very good, especially with modern treatments. Most asthma attacks can be managed quickly, and many people with asthma live active, healthy lives. By sticking to your asthma action plan, attending regular reviews, and promptly treating attacks, you can reduce the impact asthma has on your daily life. Severe attacks are scary, but with the right care, recovery is the rule. Always let your healthcare team know if things change.

Find support

International organisations

• Asthma + Lung UK ↗
• Global Allergy & Airways Patient Platform ↗

Local organisations

• British Lung Foundation (now part of Asthma + Lung UK) ↗ · UK
• Allergy & Asthma Network ↗ · US
• Asthma Australia ↗ · Australia
• Asthma Canada ↗ · Canada

Helplines

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