Asthma attack: what to do, when to call 999 and what happens afterwards

Asthma is a long-term condition in which the airways become swollen and narrow, which causes wheezing, coughing, shortness of breath and a tight chest. The NHS explains that these symptoms usually come and go and may be worse at night and early in the morning. An asthma attack is when the symptoms become severe and it is difficult to breathe.

Attacks can be set off by the same things that trigger milder symptoms. The NHS lists exercise, high levels of air pollution, cold air and contact with something you are allergic to, such as pollen, dust, mould or animals. The NHS also notes that viruses such as flu can make asthma symptoms worse, which is why it lists vaccinations such as the flu vaccine among the things that help.

This page concentrates on adults. Asthma + Lung UK points out that its emergency advice is written for adults and that separate guidance applies if a child has an attack, so parents and carers should look for guidance written for children.

Asthma + Lung UK says you may be having an attack if your symptoms are getting worse quickly, if your reliever inhaler does not seem to be helping as much as usual or you need it more often, if you are finding it difficult to walk or talk, or if your peak flow reading is much lower than usual. You may have all of these signs or only some of them.

It is worth knowing that an attack does not always look the way people expect. The charity notes that you may not hear a wheeze, and that your peak flow reading may even be normal, despite having symptoms. If you feel that something is seriously wrong with your breathing, treat it as an attack and follow the steps below.

NHS inform adds signs that mean you should phone 999 or go to A&E: severe difficulty breathing, such as struggling to speak without pausing, gasping or choking; feeling more drowsy than usual or finding it harder to wake up; and lips or skin turning pale, blue or grey. Chest pain that does not go away is also listed, because it can point to another serious problem.

The steps differ slightly depending on which type of reliever inhaler you have. Your personal asthma action plan may give a different maximum dose, and if so you should follow your plan. The NHS and Asthma + Lung UK give the same general approach.

• Sit up straight and try to stay calm.

• Use your reliever inhaler straight away. With a spacer if you have one, shaking the inhaler between each puff.

• Blue reliever: take 1 puff every 30 to 60 seconds until you feel better, up to a maximum of 10 puffs.

• AIR or MART inhaler: take 1 puff every 1 to 3 minutes until you feel better, up to a maximum of 6 puffs.

• Call 999 if you feel worse at any point, if you do not feel better after the maximum number of puffs, or if you do not have a reliever inhaler with you.

• If the ambulance has not arrived after 10 minutes and you are not improving, use the inhaler again, up to the same maximum dose.

The table summarises the figures given by the NHS. It is not a substitute for the instructions in your own asthma action plan, which can differ.

Someone in the middle of an attack is often frightened, and anxiety can make breathing feel even harder. Asthma + Lung UK advises reassuring them and helping them to stay as calm as possible, helping them sit up in a comfortable position and helping them use their reliever inhaler by following the same guidance.

If they do not have a reliever inhaler with them, call 999 straight away. Call 999 as well if they do not feel better or if you are worried at any point. Do not wait to see whether things improve on their own. The NHS also advises against driving a person with a severe attack to A&E yourself, and says the person you speak to at 999 will advise what to do.

If an attack does not get better, or is severe from the start, you may need to be treated in hospital. The NHS says hospital treatment may include oxygen through a mask, a nebuliser to breathe in high doses of medicine, and steroid tablets or injections.

Many people feel dramatically better after hospital treatment and want to get on with life. The advice is still to see your GP or asthma nurse afterwards, because the follow-up appointment is there to review your treatment and lower the risk of another attack.

The NHS says to ask for an urgent GP appointment after an attack and to be seen within 2 days, even if you have recovered. The purpose is to review your treatment and to work out how to prevent another attack. Asthma + Lung UK is more specific: if you managed the attack yourself with your reliever, ask for an urgent same-day appointment; if you were treated in hospital or by paramedics, you need a follow-up no later than two working days afterwards.

Sources differ slightly in their exact wording, so the safest approach is to contact your practice as soon as you can and tell the receptionist you have had an asthma attack. Asthma + Lung UK suggests mentioning that asthma guidelines recommend an urgent appointment, as it can sometimes be hard to get one.

At the review, a GP or nurse will usually check how you use your inhalers, look at whether your preventer treatment needs changing and update your personal asthma action plan. The NHS says you should have check-ups at least once a year to see how well your treatment is working.

The NHS says there are practical steps that help prevent symptoms and attacks. Taking your inhalers as recommended by your care team and always having your reliever with you are the most important. Using the inhaler correctly matters too: a doctor, nurse or pharmacist can show you how to use your type of device, and Asthma + Lung UK has videos.

• Use your preventer or MART inhaler as prescribed, even when you feel well.

• Try to avoid known triggers such as smoke, air pollution, pollen or animals.

• Do not smoke, and ask for help to stop if you need it.

• Have vaccinations such as the flu vaccine, because viruses can make asthma worse.

• Check with a pharmacist or doctor before taking other medicines: the NHS says aspirin, ibuprofen and beta blockers can trigger asthma symptoms in some people.

• Keep to a healthy weight and exercise regularly, getting advice if exercise sets off your symptoms.

Emergency treatment for an asthma attack is provided through 999 and A&E on the NHS, and ongoing asthma care is usually led by the GP practice, with a GP or nurse supporting you and sometimes a specialist hospital doctor, as the NHS describes. People with severe asthma that is not controlled on usual treatment can be referred to a specialist respiratory team, which may offer additional treatments such as injected biological medicines, as the NHS describes.

Some people also choose a private respiratory consultant for an assessment or a second opinion. The tests used to assess asthma, such as spirometry, peak flow and tests for allergy or airway inflammation, are the same in both settings. Emergency care for an attack should never be delayed in order to arrange a private appointment.