Warning Signs of a Severe Asthma Attack

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Woman holding chest to indicate heart attack

Asthma symptoms can be triggered by a number of things: an allergen, a pollutant in the air, even an upper respiratory infection. But symptoms can appear almost anytime—asthma symptoms don’t always require an obvious trigger to make an appearance.

The real danger is when the symptoms lead to a severe asthma attack. If you can learn to readily recognize the early signs of an asthma flare-up and take action, you may be able to ward off a serious asthma attack.

5 Things You Didn't Know About Severe Asthma

Know Common Warning Signs

The most common signs of an impending asthma attack are coughing, wheezing and shortness of breath. Ideally, you would reach for your rescue inhaler as soon as you notice those early signs. Often, the right dose of a quick-acting medicine can stop the asthma attack. A typical dose would be 2 to 6 puffs of a quick-acting medicine like albuterol, which is a bronchodilator. Albuterol relaxes the muscles in your small airways, opening them up to allow for the flow of air. You should notice a decrease in wheezing and shortness of breath.

But you might not have a rescue inhaler nearby. Or your rescue inhaler works—but the effect doesn’t seem to last for very long. In that case, the attack may worsen. As the asthma attack progresses, the shortness of breath and coughing may intensify. You may feel some pain and tightness in your chest. And you may have trouble breathing, as your airways inside your lungs get even more inflamed and begin to narrow.

In an extremely severe attack, you may start breathing very fast and even experience chest retractions—that is, your skin sinks in between or around your rib bones when you inhale. Or your chest may expand and then not deflate when you exhale. You may even develop a blue tinge around your face or lips.

However, even a ready dose from a rescue inhaler may not be enough to ward off a severe asthma attack once it’s underway. When your symptoms don’t respond well to the quick-acting medication, you may need to seek out emergency care. In the emergency department, you may need a dose of a bronchodilator like ipratropium. Sometimes, people in the throes of a serious asthma attack may also need intravenous corticosteroids. In the most severe cases, a person experiencing a severe asthma attack may have to be intubated and put on a mechanical ventilator to be stabilized.

Recognize Your Triggers

Everyone has a trigger—some sort of factor that can cause an asthma flare-up. Learn to recognize your triggers so you can avoid them. If you can stay away from situations that will bring you into contact with your particular trigger, do so. Avoiding them will make you far less likely to experience an asthma flare-up, which could become serious. Common triggers include:

  • Upper respiratory illnesses

  • Allergens, such as pollen

  • Dust mites

  • Animal dander

  • Cockroaches

  • Certain extreme weather conditions

  • Strong odors

  • Airborne irritants, such as smoke or chemical fumes

Avoidance is your best strategy, but it’s not always possible. If you know you could come into contact with your particular trigger, be sure to bring along your rescue inhaler. And if you notice the warning signs of a severe asthma attack, don’t hesitate to use it, even if you can’t pinpoint the exact trigger.

Create a Treatment Plan

If you already have a treatment plan for asthma attacks but it doesn’t seem to be working very well, you may need to revisit it or update it. Also, if you notice that a few puffs from your rescue inhaler doesn’t last for very long, you may need to talk to your doctor about a different type or amount of treatment.

If you haven’t sketched out a treatment plan for handling an asthma attack, it’s definitely time to do so. Sit down with your doctor and talk about your triggers and any typical early symptoms that tend to precede a flare-up for you. You can also figure out the best type of short-acting treatment to try. If the plan doesn’t work well, don’t be afraid to speak up so you can your doctor can improve it.

Knowing the warning signs of a severe asthma attack isn’t just a good idea—this knowledge can help you ward off a severe attack before it’s too late. And in some cases, it could save you a trip to the emergency room.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 17

  1. Asthma Attack. American College of Allergy, Asthma & Immunology. http://acaai.org/asthma/symptoms/asthma-attack

  2. Asthma Attack. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/asthma-attack/home/ovc-20257806

  3. Asthma in Adults. University of Maryland Medical Center. http://umm.edu/health/medical/reports/articles/asthma-in-adults

  4. Preventing Asthma Episodes and Controlling Your Asthma. Asthma and Allergy Foundation of America. http://www.aafa.org/page/asthma-prevention.aspx

  5. What Are Asthma Symptoms? Asthma and Allergy Foundation of America. http://www.aafa.org/page/asthma-symptoms.aspx

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