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What to do in a Severe Asthma Attack Emergency

Severe Asthma Attack

When you are having a severe asthma attack, first things first: Follow the instructions in your asthma action plan for dealing with an emergency. To be prepared, it's also important that you always carry with you your rescue inhaler and spacer device or portable nebulizer if required.

1. Are you having an asthma emergency?

Signs and symptoms of a severe asthma attack emergency include:

  • Trouble walking or talking because you are short of breath
  • Not getting relief from your rescue inhaler or nebulizer treatment
  • Blue lips or fingernails
  • A peak flow reading of 50 percent or less of your personal best

Not all asthma emergencies happen quickly. A dangerous asthma attack can start in a matter of minutes or develop slowly over hours. So, even if you aren't in immediate danger, it's important to pay attention to the symptoms of an asthma attack.

Early warning signs that your asthma is getting worse include:

  • Coughing, wheezing, or tightness in your chest
  • Shortness of breath
  • Symptoms that wake you up or begin when you are active
  • A peak flow reading at 50 to 79 percent of your personal best

2. What to do first

Every person's asthma action plan can be a bit different, but it’s likely that general steps are similar.

If you are having symptoms of a severe asthma emergency:

  • Take 4 to 6 puffs of your rescue inhaler (use your spacer device if required) or use your nebulizer.
  • Go to the hospital or call 911 for an ambulance.

If you have a severe or worsening asthma attack and don't have your inhaler or nebulizer:

  • Try not to panic. Panic makes asthma worse.
  • Sit up straight and take slow deep breaths.
  • Call 911 or have someone take you to the emergency room right away.

If you are having warning symptoms of a possible asthma emergency:

  • Take 2 to 6 puffs of your rescue inhaler (use your spacer device if required) or use your nebulizer.
  • Sit upright, loosen any tight clothing.
  • Try to stay calm. Take slow, steady breaths.
  • Repeat the 2 to 6 puffs or nebulizer treatment after 20 minutes.
  • If you still have symptoms, call 911 or get to urgent care.

3. Being prepared for an asthma emergency

An asthma attack can range from mild to severe. A severe attack, also called an exacerbation, can be a medical emergency. Having an asthma action plan is the key to recognizing and managing an asthma emergency.

Work with your doctor to come up with an asthma action plan. This plan shows when you are in the green zone (controlled asthma), yellow zone (asthma warning signs) or red zone (asthma emergency). Your plan will also list instructions for what to do in each situation.

Part of your plan will probably include using a rescue inhaler containing a short-acting beta agonist (with or without a spacer device) or nebulizer to open up your lungs during an attack. You may also be taught to use a handheld device, called a peak flow meter. To use a peak flow meter, you blow a single breath into the mouthpiece as fast as you can. This measures how well you can push out air from your lungs and can indicate how severe your asthma is.

4. Emergency treatment at a hospital

If you need emergency treatment at a hospital, you may first have pulse oximetry to guide your treatment. This simple test uses a painless fingernail sensor to measure the percent of oxygen in your blood.

You may also have lung function tests, including spirometry, to get more detailed information about your condition and determine the best way to treat your attack. Doctors may also measure the amount of nitric oxide gas in your breath to see if you have inflammation in your breathing tubes.

You may also get medications for a severe asthma attack, such as:

  • Short-acting medications through a nebulizer. These medications are similar to those in your rescue inhaler, but the nebulizer is a machine that turns the medications into a mist. When you are having a severe asthma attack, using a nebulizer instead of an inhaler often makes it easier to inhale the medication deeply into your lungs.
  • An oral corticosteroid. This pill is a strong medication that reverses inflammation.
  • Other medications, called bronchodilators, that open up your airways.

Sometimes treatment for a severe asthma attack requires breathing assistance. This may involve getting supplemental oxygen or using a breathing machine called a mechanical ventilator.

The bottom line

Remember that being prepared is the best way to manage a severe asthma attack emergency. Work with your doctor to come up with an asthma action plan designed specifically for you and then keep your plan up to date.


  • Always carry your action plan, rescue inhaler, and spacer device or nebulizer if required.
  • Check in with your doctor whenever you have an asthma attack. You may need to adjust your asthma action plan.

Article references

  1. Mayo Clinic, Asthma Attack
  2. Pollart SM, Compton RM, Elward KS. Management of Acute Asthma Exacerbations. Am Fam Physician. 2011 Jul 1;84(1):40-47.
  3. National Heart, Lung, and Blood Institute, Asthma Action Plan
  4. Asthma Attack, National Health Service