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JAMA Patient Page
February 23, 2016

Asthma Attacks

JAMA. 2016;315(8):832. doi:10.1001/jama.2015.16834

Asthma attacks can range from mild to life-threatening, and it is important to know when to go to a doctor’s office or emergency department to seek treatment.

Asthma is a common lung disease caused by inflammation and narrowing of the airways. It affects both children and adults. Symptoms of asthma include wheezing, trouble breathing, chest tightness, and cough. Treatment of asthma includes inhalers and sometimes oral medications. The 2 most important types of medications for asthma are bronchodilators (which relax airways) and inhaled corticosteroids (which reduce inflammation).

What Is an Asthma Attack?

Most people with asthma will experience temporary worsening of symptoms at some point in their lives, even if they use their medications correctly. This is called an asthma “attack.” Asthma attacks can vary in severity from a mild worsening of symptoms that only require additional use of inhalers to a life-threatening event that requires immediate treatment in the hospital. Triggers for worsening asthma symptoms that may lead to an asthma attack include respiratory tract infections such as a cold, exposure to an allergen such as animal dander or dust, exposure to an irritant such as cigarette smoke, or sometimes intense exercise.

What to Do if You Are Having an Asthma Attack

If your symptoms are severe and you are completely out of breath, not able to speak in full sentences, using a lot of muscles in your chest and abdomen to breathe, or feeling sleepy, call 911. While awaiting paramedics, use a bronchodilator, specifically a short-acting beta-agonist (SABA) such as albuterol, to help control the attack.

If your symptoms are not severe, it is still important to use a SABA as the first step to controlling the attack. SABAs are usually delivered by a “rescue” inhaler. Sometimes, instead of an inhaler, a nebulizer machine can be used. A nebulizer turns the medication into a mist that can get into the lungs with less effort than that required when using an inhaler and may be preferred for some patients who are very short of breath. Treatment with SABAs can be repeated every 20 minutes for an hour if symptoms do not resolve after the first treatment. Do not delay using a SABA when you feel an asthma attack starting.

After the first hour, the next step for treating mild or moderate asthma attacks depends how good the response has been to the SABA. This is based both on symptoms (how you feel) and, in some cases, on your peak flow, a measurement of how fast you can blow air out of your lungs. Peak flow is useful because some people, especially children, have trouble gauging how severe their symptoms are. A peak flow meter is inexpensive and may be useful for people with moderate or severe asthma.

If your symptoms resolve after the first hour, you can continue using the SABA as needed every 3 to 4 hours for the next 1 to 2 days. Avoid any known triggers and keep taking your regular asthma medications. If your symptoms improve but do not resolve, see your doctor or visit an urgent care center for further management. If your symptoms do not improve, seek immediate treatment by going to the emergency department or calling paramedics.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab. A JAMA Patient Page on childhood asthma was published in the January 25, 2012, issue and one on adult asthma in the July 21, 2004, issue.

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Article Information
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source:National Heart, Lung, and Blood Institute

Topic: Pulmonary Medicine

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