Am I Having an Asthma Attack? How to Tell and What to Do
What an asthma attack feels like
Inhale, exhale, repeat. Breathing is just that simple for most people. But for those with asthma, sudden symptoms focus their full attention on this otherwise intuitive reflex.
“You notice your breathing more [and] feel every breath,” says Laurence Jones, a photographer from the United Kingdom who lives with the chronic respiratory disease. “It’s uncertain, troubling.”
While Jones has had mild, well-managed asthma since childhood, he’s experienced a few severe asthma attacks in his life.
“That’s really scary,” he says. “You breathe in, but the air doesn’t fill your lungs, like you are drowning in the open air.”
What is asthma?
The difficulty breathing that Jones describes can occur because of hypersensitive airways, explains Mitchell Grayson, MD, chair of the Allergy and Asthma Foundation of America (AAFA) medical scientific council and director of the division of allergy and immunology at The Ohio State University.
The airways are tiny tubes where air moves in and out of the lungs. In people with asthma, some kind of trigger makes their airways overreact, inflame, and narrow. The muscles around the airways can also tighten up as a part of this response, increasing chest pressure even more.
“What ends up happening is that [a person] can’t breathe air out,” he says. “The air gets stuck behind these constrictions.”
That’s what prompts the hallmark symptoms of an asthma attack—also known as an acute asthma exacerbation—including wheezing, coughing, and shortness of breath.
The chronic disease affects about 262 million people worldwide, according to the World Health Organization. Major advancements in treatment over the last few decades have led to declining mortality rates, enabling many people with asthma to lead normal, healthy lives.
But the WHO says that about 461,000 people still die prematurely of asthma each year—and 2016 research published in Multidisciplinary Respiratory Medicine shows that the majority of today’s deaths from asthma attacks are preventable.
What are asthma attack symptoms?
“Usually [an asthma attack] is not terribly subtle,” Dr. Grayson says.
He explains that signs of an asthma attack often include:
- Shortness of breath, coughing, and breathing difficulties
- Feeling like you can’t breathe air out
- Wheezing—or a whistling noise as you exhale
- Inability to speak in full sentences
These asthma attack symptoms can last a couple of hours for some people, he explains. In others, they might last for days.
“And some people die,” Dr. Grayson says. That’s why anything that’s limiting daily activities should be evaluated by your doctor right away.
When people treat an attack as soon as it starts—and take controller medicine to prevent attacks in the first place—their risks reduce and outcomes improve, he says.
Controller medications, often a corticosteroid, can be taken daily on a long-term basis to control underlying inflammation.
They differ from rescue medications, like albuterol, which people take via an inhaler or nebulizer (a machine that vaporizes medication into a mist that can be inhaled) to open airways when they are experiencing asthma symptoms. (Read on for more on controller and rescue medications.)
What to do during an asthma attack
Everyone with asthma should have and follow a doctor-designed asthma action plan, says says Joi Lucas, MD, a pediatric pulmonologist and chief of pediatrics at Lakeland Regional Health in Lakeland, Florida.
This personalized plan provides clear instructions for someone’s day-to-day asthma management.
It also indicates what to do if symptoms worsen—such as during an attack—clarifying measures like which medications to take and when to seek professional care.
Dr. Lucas explains that these plans typically have three management sections that correlate with the severity of someone’s current symptoms, including:
- The green zone: You’re not having symptoms and should take your daily medication as prescribed.
- The yellow zone: Symptoms like coughing, wheezing, or shortness of breath are present, and you should refer to this section of your plan for guidance on which and how much of your medicines to take.
- The red zone: This indicates a breathing emergency that requires immediate medical treatment. Someone in this zone might be experiencing severe symptoms and/or getting no relief from their medications.
An asthma action plan can also help people recognize the early warning signs of a serious attack, like feeling tired and out of breath, having an irritating cough, or developing cold or allergy symptoms.
What causes an asthma attack?
People with asthma are sensitive to specific triggers, explains Dr. Grayson. Triggers are substances or situations that generally wouldn’t bother the average person.
Allergens like dust, pollen, and pet hair are the most common culprits, with about 60 percent of people with the disease experiencing symptoms thanks to this variety of allergic asthma, according to AAFA.
But there are multiple pathways through which asthma can develop—and an allergen isn’t always the driver of airway inflammation. Other common asthma triggers include:
- Changes in weather (like sudden exposure to cold air or humidity)
- Catching a virus, like a cold or the flu
- Air irritants like pollution, tobacco smoke, and workplace chemicals
Learn more about surprising asthma causes.
When do asthma attacks occur?
Not every exposure to a trigger will lead to an asthma attack. Dr. Grayson says that people’s risk of an exacerbation depends on a range of factors, like:
- How much of a trigger they’re exposed to
- How sensitive their airways are
- If they’re sick with a cold or the flu
- How well they’re following their prescribed treatment plan
Yet attacks can sometimes seem to come out of nowhere, and even mild cases of asthma can unexpectedly produce symptoms, says Dr. Lucas.
Some scenarios can also make it more difficult for people to control their asthma, such as:
- Having another chronic condition, like diabetes or obesity
- Being a smoker
- Incorrectly using asthma medication, including having poor inhaler technique (Here’s how to use an inhaler correctly)
Why asthma attacks are dangerous
Because asthma inflammation constricts the airways of the lungs, an attack can be potentially life threatening when this narrowing keeps someone from being able to breathe. That’s why Dr. Lucas says that everyone with the disease—even those with well-controlled asthma—should carry a rescue inhaler that can quickly open up the airways in an emergency.
But even mild asthma symptoms can have a big effect over time.
“Repeated episodes left untreated can perpetuate airway inflammation,” explains Sumita Khatri, MD, an adult pulmonary and intensive care unit physician and member of AAFA’s medical scientific council.
This can result in asthma that is more severe and harder to control—and leads to a quicker decline in lung function.
There’s a link between uncontrolled asthma and other health conditions, according to research in Current Opinion in Allergy and Clinical Immunology. They include:
- Upper airway diseases like rhinitis and sinusitis
- Heart conditions
- Gastroesophageal reflux disease
- Anxiety, depression, and behavioral disorders
The study didn’t look at cause and effect, so it’s possible poorly managed asthma causes these conditions or having these conditions raises the risk for uncontrolled asthma.
Can asthma attacks be prevented?
Asthma is a lifelong condition that doesn’t yet have a cure. But people can reduce their risk of having asthma attacks by controlling airway inflammation with the right treatment.
Several types of asthma treatments are available today, and researchers continue to develop new, targeted approaches. In general, using a daily controller medication—and keeping rescue medication on hand—help most people manage the disease.
Daily controller medicines work by reducing the airway inflammation that asthma causes. Dr. Grayson says that this effect makes it less likely for people to experience severe symptoms in the presence of a trigger.
Rescue medications like albuterol treat attack symptoms as they occur by quickly relaxing and opening the airways.
Some people might also use a peak flow meter to measure how well air flows in and out of their lungs day to day. A dip in this reading can signal the beginning of an attack—even before symptoms aris. Monitoring this metric allows for swifter treatment, often before an attack is in full swing.
These asthma treatments work hand in hand to help people reduce the number and severity of attacks—and keep any acute exacerbations from becoming dangerous. Today’s medications have contributed to a dramatic decline in asthma mortality rates over the last several decades, according to a 2019 study in the European Respiratory Journal.
What does well-controlled asthma look like?
Dr. Lucas says that asthma is considered “under control” when a person is experiencing symptoms fewer than twice a week and has no issues with normal activities.
Following an asthma action plan is what helps people reach this level of asthma management, she explains. But since the disease can change over time, it’s important that people review their plan’s effectiveness with their doctor annually.
A simple rule, she says, is that if asthma symptoms are present, medications are still needed to keep the disease in check and prevent serious attacks.
- Mitchell Grayson, MD, chair of the Asthma and Allergy Foundation of America's medical scientific council and director of the division of allergy and immunology at The Ohio State University
- Joi Lucas, MD, chief of pediatrics at Lakeland Regional Health in Lakeland, Florida
- Sumita Khatri, MD, an adult pulmonary and ICU physician and member of the Asthma and Allergy Foundation of America's medical scientific council
- Laurence Jones, photographer from the United Kingdom who has asthma
- Asthma and Allergy Foundation of America: "Allergens and Allergic Asthma"
- World Health Organization: "Asthma"
- Multidisciplinary Respiratory Medicine: "Asthma-related deaths"
- Current Opinion in Allergy and Clinical Immunology: "Asthma and comorbidities"
- European Respiratory Journal: "Asthma progression and mortality: the role of inhaled corticosteroids"