Complete Guide to Treating an Asthma Attack: First Aid Training from St John Ambulance
This comprehensive guide covers everything you need to know about recognizing and treating an asthma attack using proven first aid techniques. Whether you’re a parent, teacher, caregiver, workplace first aider, or simply want to be prepared to help someone in an emergency, understanding how to respond to an asthma attack is an essential life skill. This St John Ambulance first aid training resource provides step-by-step instructions that could help save a life when someone experiences breathing difficulties due to asthma.
According to the World Health Organization, approximately 262 million people worldwide are affected by asthma, and this chronic respiratory condition accounts for over 450,000 deaths annually. In the United Kingdom alone, Asthma + Lung UK reports that someone experiences a potentially life-threatening asthma attack every 10 seconds, highlighting the critical importance of widespread first aid knowledge in our communities.
Understanding Asthma and Why Attacks Happen
Asthma is a chronic respiratory condition that affects the airways in the lungs. People with asthma have sensitive airways that can become irritated and inflamed when exposed to certain triggers. During normal breathing, the muscles around the airways are relaxed, allowing air to flow freely in and out of the lungs. However, during an asthma attack, several things happen simultaneously that make breathing increasingly difficult.
The muscles surrounding the airways tighten and constrict, a process known as bronchospasm. The lining of the airways becomes swollen and inflamed, further reducing the space available for air to pass through. Additionally, the airways produce excess mucus, which can clog the already narrowed passages. This combination of factors creates the characteristic wheezing, coughing, and shortness of breath associated with asthma attacks.
Common Asthma Triggers
Understanding what can trigger an asthma attack helps in both prevention and treatment. Common triggers include respiratory infections such as colds and flu, allergens like pollen, dust mites, pet dander, and mold spores. Environmental factors such as cigarette smoke, air pollution, strong chemical odors, and cold air can also provoke attacks. Physical exercise, emotional stress, and certain medications including aspirin and ibuprofen may trigger symptoms in some individuals. Weather changes, particularly cold or humid conditions, are also known to affect people with asthma.
Recognizing the Signs of an Asthma Attack
Being able to quickly identify when someone is having an asthma attack is crucial for providing effective first aid. The faster you recognize the symptoms, the sooner you can help the person access their treatment of asthma medication and begin the recovery process.
Early Warning Signs
An asthma attack often begins with subtle warning signs before progressing to more severe symptoms. The person may start coughing, particularly at night or early in the morning. They might complain of feeling tight in the chest or experiencing mild shortness of breath. You may notice them breathing faster than usual or seeming slightly anxious about their breathing. These early signs provide an opportunity to intervene before the attack becomes more serious.
Symptoms of a Developing Attack
As an asthma attack progresses, the symptoms become more pronounced and harder to ignore. The person will typically experience difficulty breathing, often described as not being able to get enough air in. Wheezing becomes audible—a high-pitched whistling sound that occurs when breathing out, though it can sometimes be heard when breathing in as well. Persistent coughing that doesn’t seem to help clear the airways is common. The person may have difficulty speaking in full sentences and need to pause frequently to catch their breath. They will often instinctively sit upright and lean forward, as this position makes breathing slightly easier.
Signs of a Severe Asthma Attack
A severe asthma attack is a medical emergency requiring immediate action. Warning signs include the person’s reliever inhaler not providing relief after the usual number of puffs. Their lips, fingernails, or face may take on a bluish or grayish tinge, indicating poor oxygen levels in the blood. The person may become exhausted from the effort of breathing and appear drowsy or confused. In very severe cases, the wheezing may actually become quieter as less air is moving through the airways—this silent chest is an ominous sign. The person may be unable to speak at all, and you might notice their ribs or the base of their throat pulling in sharply with each breath as they struggle to get air.
Step-by-Step Treatment of Asthma Attacks
When someone experiences an asthma attack, following these first aid steps can help stabilize their condition and potentially save their life. Stay calm and reassure the person, as anxiety can worsen their symptoms.
Step 1: Help the Person Sit Comfortably
Assist the person into a comfortable sitting position. The ideal position is sitting upright, slightly leaning forward with their hands resting on their knees. This position, sometimes called the tripod position, helps open the airways and makes breathing easier. Never lay an asthma sufferer down flat during an attack, as this can make breathing more difficult. If they’re outdoors and it’s cold, try to move them to a warmer environment if possible, as cold air can worsen symptoms.
Step 2: Assist with Their Reliever Inhaler
Help the person locate and use their reliever inhaler. Reliever inhalers are typically blue and contain fast-acting medication, usually salbutamol (also known as albuterol), that works within minutes to relax the muscles around the airways. The standard approach recommended by medical professionals is to have the person take one puff of their inhaler, then wait 30 to 60 seconds before taking another puff. They can take up to 10 puffs if needed during a severe attack.
If the person has a spacer device, encourage them to use it with their inhaler. A spacer is a hollow tube that attaches to the inhaler and makes it easier to get the medication deep into the lungs where it’s needed. This is particularly helpful during an attack when the person may struggle to coordinate their breathing with operating the inhaler. For those using a spacer, the technique involves pressing the inhaler once into the spacer and then taking four to five breaths through the spacer mouthpiece before repeating the process.
Step 3: Stay Calm and Reassuring
Your demeanor during the emergency can significantly impact the person’s condition. Panic and anxiety can trigger the release of stress hormones that cause airways to tighten further. Speak in a calm, steady voice and provide gentle reassurance. Encourage slow, steady breathing if possible—breathing in through the nose and out through pursed lips can help. Loosen any tight clothing around their neck and chest to help them feel less restricted.
Step 4: Monitor and Reassess
After the person has used their inhaler, monitor their condition closely. The medication in reliever inhalers typically begins working within a few minutes. If their symptoms improve and they’re breathing more easily, have them rest quietly and avoid any activities that might trigger another attack. Stay with them until you’re confident they’ve recovered.
Step 5: Call Emergency Services if Necessary
Call for emergency medical assistance immediately if any of the following apply: the person doesn’t have their reliever inhaler with them, their inhaler doesn’t seem to be helping after 10 puffs, their symptoms are getting worse despite using the inhaler, they’re too breathless to talk or eat, their lips or fingernails are turning blue or gray, they’re becoming exhausted or drowsy, or you’re in any doubt about the severity of the attack. When calling emergency services, clearly state that the person is having an asthma attack and describe their current symptoms.
Understanding Different Types of Inhalers
People with asthma may carry different types of inhalers, and understanding their purposes helps provide effective first aid assistance.
Reliever Inhalers
Reliever inhalers, most commonly blue in color, are the first line of defense during an asthma attack. They contain short-acting bronchodilator medications that quickly relax the muscles around the airways, providing rapid relief from symptoms. These inhalers are designed for immediate use when symptoms occur and work within minutes. Common medications include salbutamol and terbutaline.
Preventer Inhalers
Preventer inhalers, often brown, orange, or red, contain corticosteroid medication that reduces inflammation in the airways over time. These inhalers are used daily as part of ongoing treatment of asthma and are not effective for treating an acute attack. They work by preventing attacks from occurring when used consistently, but they cannot provide immediate relief during an emergency.
Combination Inhalers
Some people use combination inhalers that contain both a preventer medication and a long-acting reliever. These are typically used for daily maintenance rather than emergency relief. During an asthma attack, the person should use their separate reliever inhaler if they have one.
Special Considerations for Different Groups
Children with Asthma
Treating asthma attacks in children requires additional patience and reassurance. Children may become frightened during an attack, which can worsen their symptoms. Use age-appropriate language to explain what you’re doing and why. If the child is very young, they may need help operating their inhaler, and a spacer with a face mask attachment may be necessary. Schools and childcare facilities should have asthma action plans on file for children with diagnosed asthma.
Elderly Individuals
Older adults may have additional health conditions that complicate asthma attacks. They may also have difficulty using inhalers due to reduced hand strength or coordination. Be prepared to provide extra assistance and monitor for signs of confusion or exhaustion, which may indicate more severe oxygen deprivation.
Prevention and Long-Term Management
While knowing how to treat an asthma attack is essential, prevention remains the best approach. People with asthma should work with their healthcare providers to develop a comprehensive asthma action plan that identifies their triggers, outlines daily medication routines, and provides clear instructions for handling attacks of varying severity.
Regular use of preventer inhalers as prescribed, avoiding known triggers, maintaining a healthy lifestyle, and attending regular medical check-ups all contribute to better asthma control and fewer emergency situations.
Frequently Asked Questions About Asthma Attack First Aid
What should I do if someone is having an asthma attack but doesn’t have their inhaler?
If someone is having an asthma attack without access to their inhaler, call emergency services immediately. While waiting for help, keep the person calm and sitting upright, loosen any tight clothing, and encourage slow, steady breathing. If you’re in a public place, ask if anyone nearby has a reliever inhaler, as the medication is the same regardless of the brand. Some first aid kits in schools, workplaces, and public venues may contain emergency inhalers.
How many puffs of a reliever inhaler should someone take during an asthma attack?
During an asthma attack, the person should take one puff of their reliever inhaler, wait 30 to 60 seconds, and repeat if necessary. They can take up to 10 puffs during a severe attack. If symptoms haven’t improved after 10 puffs, or if they worsen at any point, call emergency services immediately while continuing to administer puffs every few minutes until help arrives.
Can I give someone else my reliever inhaler during an emergency?
In a genuine emergency where someone is having a severe asthma attack and has no access to their own medication, sharing a reliever inhaler could be life-saving. The active ingredients in blue reliever inhalers are standardized, and the immediate risk of an untreated severe asthma attack outweighs concerns about sharing medication. However, this should only be done in true emergencies, and emergency services should still be called.
How long does it take for a reliever inhaler to work?
Reliever inhalers typically begin working within a few minutes of use, with most people experiencing noticeable improvement within 5 to 15 minutes. The medication relaxes the muscles around the airways, allowing them to open up and improve airflow. If there’s no improvement within 10 minutes despite using the inhaler correctly, this indicates a severe attack requiring emergency medical attention.
Should someone lie down during an asthma attack?
No, lying down during an asthma attack is not recommended and can actually make breathing more difficult. The best position is sitting upright, slightly leaning forward with hands resting on the knees. This position, known as the tripod position, helps maximize the space available for the lungs to expand and makes breathing easier during an attack.
What’s the difference between an asthma attack and a panic attack?
While both conditions can cause breathing difficulties and may feel similar, there are important differences. Asthma attacks typically involve wheezing, coughing, and tight chest sensations that respond to reliever inhalers. Panic attacks often include rapid heartbeat, sweating, trembling, and a sense of impending doom, but don’t produce wheezing sounds. If you’re unsure, treat the situation as an asthma attack and seek medical help, as it’s safer to err on the side of caution.
When should I call an ambulance for an asthma attack?
Call emergency services if the person’s reliever inhaler isn’t helping, if they’re too breathless to speak or complete sentences, if their symptoms are getting worse despite treatment, if their lips or fingernails are turning blue, if they’re becoming exhausted or confused, or if you have any concerns about the severity of the attack. It’s always better to call for help and not need it than to delay calling during a genuine emergency.
📅 Last updated:
