Asthma attack symptoms usually come as a tight chest, wheezing, a cough that won’t quit, and trouble getting air in or out. If your reliever medicine isn’t easing symptoms or your breathing is still very hard, call 911 now, as the NHLBI asthma attack guidance advises.
What are the signs of an asthma attack?
UF Health’s signs of an asthma attack page lists four symptoms that can signal asthma: coughing during the day or at night, wheezing, breathing problems, and chest tightness. Chicago ENT’s asthma attack guide describes more signs in detail:
| Sign | What it can look like |
|---|---|
| Shortness of breath | Breathlessness that comes on suddenly or without warning |
| Wheezing | A high-pitched whistle, first when you breathe out and later when you breathe in as the attack worsens |
| Chest tightness | Pressure or a heavy weight in the chest, or a sharp pain or dull ache |
| Persistent cough | A dry cough that keeps going |
| Gasping for breath | A feeling that you can’t get enough air |
| Rapid breathing | The skin between your ribs or around your chest pulls in when you breathe in |
| Difficulty speaking | Short breath makes it hard to get through a sentence |
| Sweating and pale face | A cold sweat, with your face looking pale |
| Blue lips or fingernails | A bluish color, which Chicago ENT says means less oxygen in the blood and needs prompt medical attention |
Chicago ENT also lists sudden anxiety or panic as a sign. Early warning signs, according to UF Health, can include being short-tempered, irritable, nervous or edgy.
How can an asthma attack start?
The NHLBI says that for some people an attack starts with coughing. The chest may feel tight or like someone is sitting on it, and you may start to wheeze or feel lightheaded. UF Health notes that the cough can wake you at night. Some people say it feels like having the air sucked out of them, or like trying to suck air in through a straw.
What does an asthma attack feel like?
The NHLBI describes the attack as swelling or tightening that narrows the airways, so breathing gets harder. Here is the simple version: the tubes that carry air to your lungs swell, and the muscles around them squeeze. Less air gets through, and you have to work harder for each breath. Attacks can come on quickly or build gradually, and they can be life-threatening.
How do you tell an asthma attack from a heart problem?
Chest tightness and shortness of breath can also be signs of a heart attack. The Office on Women’s Health heart attack symptoms page says the most common heart attack symptom is pain or discomfort in the center of the chest, and that women may also have shortness of breath, nausea or extreme fatigue. It adds: “Even if you are not totally sure you are having a heart attack, call 911 right away.” If you can’t tell which it is, treat it as an emergency.
What should you do during an asthma attack?
Chicago ENT’s guide gives these steps. Stay calm and take slow breaths in through your nose and out through your mouth, because panic can make symptoms worse. Use your quick-relief inhaler as directed. The NHLBI says to use your reliever as soon as symptoms start. Sit up, and follow your asthma action plan if you have one.
What calms down an asthma attack?
Chicago ENT says the rescue inhaler can open your airways and ease symptoms. Calm breathing and sitting up help too. If you don’t feel better, the next step is emergency care, covered below.
Is it better to sit up or lie down during an asthma attack?
Sit up. Chicago ENT’s guide says “Sit up straight: Don’t lie down,” because sitting upright can help open your airways and ease breathing.
What to do for an asthma attack without an inhaler?
If you have no reliever inhaler and your symptoms are serious or breathing is very hard, seek emergency care or call 911. The NHLBI says to follow your asthma action plan and to call 911 if your medicines are not relieving symptoms or if breathing is still very hard. UF Health adds that you should call 911 or your local emergency number right away if you are having trouble walking or talking because it is so hard to breathe, you are hunching over, your lips or fingernails are blue or gray, or you are confused or less responsive than usual.
What are some home remedies for asthma wheezing, or what to drink to calm asthma?
Drinks and home remedies are not a substitute for your reliever or the steps above. The steps that help during an attack are staying calm, breathing slowly, sitting up and using your plan. If wheezing keeps going or gets worse, use your plan and call for help.
When should you go to the ER for asthma?
The NHLBI says to go to the emergency room if your symptoms do not go away soon after taking your at-home medicines, or if you have a serious attack. At the ER you may get medicine through a nebulizer, a small machine that turns liquid medicine into a mist you breathe in, or through an IV line in your arm. In severe cases you may also need oxygen or a ventilator.
The NHLBI also says to call your provider if your medicines do not relieve an attack, or if your peak flow number is low and you use a peak flow meter. The NHLBI says to seek care right away if you or your child have symptoms and have been hospitalized for asthma in the past year, have had life-threatening attacks, or use more than one canister of a reliever medicine each month.
What are the treatment options for asthma?
The NHLBI’s attack guidance describes treatment in four parts: a reliever for sudden symptoms, controller medicines, an asthma action plan, and emergency care. The table puts those side by side with one study you may see mentioned.
| Option | What the source says | Who it suits and its limits |
|---|---|---|
| Reliever (quick-relief) inhaler | Use it as soon as symptoms start, per the NHLBI. Chicago ENT says it can open your airways. | Your plan sets how to use it. Using more than one canister a month is a reason to seek care, per the NHLBI. |
| Controller medicines | Named in the NHLBI’s action plan guidance, alongside the reliever. Your plan says when to step up. | Your clinician decides whether you need one and which one. |
| Asthma action plan | A written plan that explains how to tell your asthma is getting worse and when to increase medicines. | Ask your clinician to help you write one. Chicago ENT says to follow it closely. |
| Emergency care | Nebulizer mist, IV line, oxygen or ventilator, per the NHLBI. | For serious attacks, or when symptoms do not go away after at-home medicine. |
| Non-medicine steps | Chicago ENT advises staying calm and sitting up during an attack. Health.gov says secondhand smoke can cause severe asthma attacks in babies and children. | These work alongside your medicine, not in place of it. |
Costs vary by insurance plan and pharmacy, so check the price of your exact inhaler with your pharmacy before you pick one. For the types of inhalers and how each one is used, see our asthma inhaler types guide.
What about inhaled steroids after an ER visit?
A 1998 randomized controlled trial in The Journal of Asthma, indexed on PubMed, compared inhaled budesonide with tablet prednisolone as follow-up after an ER visit for an acute attack. The trial included 81 patients. Lung function (FEV1) rose 17.3% with budesonide and 17.6% with prednisolone over seven days. The authors concluded that high-dose inhaled budesonide may be a substitute for oral therapy as follow-up after an acute attack. Ask your clinician whether this applies to you.
What causes an attack to start?
Triggers differ from person to person. Our asthma triggers guide goes through the common ones and how to reduce your exposure.
What about asthma symptoms and attacks in kids?
For young children, the NHLBI says to call 911 if they seem drowsy, confused or troubled, have a blue tint to the skin and lips, or have a fast heartbeat.
A 2022 qualitative systematic review in the Journal of Asthma and Allergy, indexed on PubMed, looked at 17 studies of parents caring for a child aged 2 to 12 during an acute attack at home. It found two processes shaped whether parents sought medical help: past experiences that inform future decisions, and factors that push parents to get help. The review concludes that asthma education should address the parent’s experience, not only symptoms, triggers and devices.
If your baby or 1-year-old may have asthma symptoms, ask your child’s pediatrician what to watch for and when to get care.
What if you smoke or vape?
If you smoke or vape, CDC says tobacco dependence often requires multiple tries to quit successfully. The CDC smoking cessation fast facts also say that using counseling and medication together provides the best chance of quitting successfully. The health.gov page also notes that e-cigarette aerosol is not harmless. Our vaping dangers page covers the symptoms and quitting options in more detail.
What to bring to your next appointment
Your clinician will decide which treatment fits you. These notes help that conversation:
- When your symptoms start, and what was going on at the time.
- How often you use your reliever, since frequent use is a signal the NHLBI flags.
- Whether your night cough or breathlessness wakes you. Our shortness of breath at night page covers those signs.
- Whether you have an asthma action plan, and whether you follow it.
If you want to know what a clinician can measure, our lung health and breathing tests page explains what breathing tests are for.
If breathing is very hard, or your reliever is not relieving symptoms, call 911 now.
By SmokersLung.com Respiratory Health Education Team