What do I do if someone is having an asthma attack?
Sit them up, use the reliever inhaler at the right interval, and know the three triggers for 999. Plus what to do if the ambulance is more than ten minutes away.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 4 min
- Safety
- warning
Short answer
Sit them up straight and help them stay calm. With a blue reliever inhaler, one puff every 30 to 60 seconds until they feel better, up to a maximum of 10 puffs. With an AIR or MART inhaler, one puff every 1 to 3 minutes, up to 6 puffs. Ring 999 if they get worse at any point, if the maximum dose has not helped, or if there is no inhaler. If no better after 10 minutes and no ambulance yet, repeat the doses.
An asthma attack is frightening to watch and the useful actions are few and specific. The commonest mistakes are laying the person down, telling them to breathe into a bag, and waiting too long before ringing — all of which come from good intentions.
Safety
Step by step
- Sit them up straight.Not lying down, and not slumped forwards over their knees. Upright opens the chest and helps the breathing muscles work. Loosen anything tight around the neck or chest.
- Help them stay calm.Panic worsens breathlessness and breathlessness worsens panic. Speak slowly, stay with them, and do the counting for them between inhaler puffs so they have something external to follow.
- Use their reliever inhaler at the right interval.For a blue reliever, NHS advice is one puff every 30 to 60 seconds until they feel better, up to a maximum of 10 puffs. For an AIR or MART inhaler, one puff every 1 to 3 minutes, up to a maximum of 6 puffs. Use a spacer if there is one — it delivers far more of the dose.
- Ring 999 on any of the three triggers.They feel worse at any point. They do not feel better after the maximum number of puffs. They do not have an inhaler with them at all. Any one of those is an ambulance call.
- Repeat the doses if the ambulance is delayed.NHS advice is that if symptoms are no better after 10 minutes and the ambulance has not arrived, use the inhaler again up to the same maximum. Waiting empty-handed is not the instruction.
- Watch for the signs that they are deteriorating.Too breathless to speak in full sentences, blue or grey lips or fingers, drowsiness or confusion, exhaustion, or a chest that goes quiet. All of them mean ring 999 immediately if you have not.
- Stay with them and be ready.If they become unresponsive, check breathing. Breathing normally means the recovery position; not breathing normally means CPR and 999.
- Get them reviewed afterwards.Anyone who has had an attack needing more than their usual reliever should be seen — NHS advice is a same-day appointment after an attack. It usually means the underlying control needs changing rather than the rescue treatment.
Tips
- A spacer makes an enormous difference to how much of an inhaler dose reaches the lungs, particularly in a child or during an attack when the breathing is fast and shallow. Anyone with asthma should have one.
- Ask early where the inhaler is. Hunting for it is where the time goes.
- Cold air, smoke, pollen, exercise and a chest infection are common triggers. Getting away from an obvious trigger is worth doing while the inhaler works.
Common mistakes
- Laying the person down — It makes breathing harder. Sitting up straight is the position in the guidance and it is the opposite of the instinct to make someone comfortable.
- Breathing into a paper bag — That is folklore for hyperventilation and it is actively harmful in asthma, where the problem is getting air out of narrowed airways rather than too much oxygen.
- Waiting to see if the inhaler works before calling — The 999 triggers are getting worse, or not improving after the maximum dose. Both are reached quickly, and severe asthma attacks kill people who waited.
- Driving them to hospital — NHS advice is not to. An ambulance crew can treat on the way, and someone whose breathing is failing should not be in a car.
If it doesn't work
They cannot speak in full sentences
Cause: A severe attack — Fix: Ring 999 now. Being unable to complete a sentence is one of the clearest markers of severity and it does not need any other confirmation.
The inhaler seems to be doing nothing
Cause: An empty or expired inhaler, poor technique, or an attack severe enough not to respond — Fix: Ring 999 and keep using the inhaler as directed while you wait. Check the technique — a spacer, slow deep breath, hold for ten seconds — but do not spend time troubleshooting instead of calling.
A child is quiet and still during an attack
Cause: Exhaustion, which is a serious sign rather than a settling one — Fix: Ring 999. A child who stops struggling and goes quiet during an asthma attack is deteriorating, not improving.
Questions people ask
Can I use someone else's inhaler on them?
In an emergency where the person has no inhaler, ring 999 first and follow the handler's instructions — they will tell you what to do with what is available. As a general rule, prescribed medicines belong to the person prescribed them.
What is the difference between a blue and a brown inhaler?
Blue is the reliever, taken during symptoms to open the airways. Brown, or another colour, is usually the preventer, taken daily to reduce inflammation. The preventer does nothing during an attack.
Does an asthma attack always involve wheezing?
No, and a chest that has gone quiet during a severe attack is a serious sign rather than a reassuring one. Wheeze can disappear when too little air is moving.
What is an asthma action plan?
A written plan agreed with a clinician setting out what to take daily, what to do when symptoms worsen, and when to seek help. Anyone with asthma should have one, and it should be somewhere the household can find it.