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Recognizing An Asthma Attack

What Do You Do During an Asthma Attack?


Early Warning Signs 

Lack of appetite, fatique, headache, trouble sleeping, feeling tired, dark circles under the eyes, and less tolerance for exercise are typical warning signs

 Common Symptoms of an Asthma Attack 

Coughing ● Chest pain or tightness ● Shortness of or gasping for breath ● Wheezing ● Flushed, pale, ashen or bluish looking skin ● Speaking in clipped or short bursts of speech 


1. Have the person STOP whatever activity he/she is doing.

  • Send another person to get help. DO NOT leave the person alone.
2. Follow the person’s Asthma Action Plan or emergency plan if there is one.  

3. If the individual has a Quick Relief Rescue INHALER or NEBULIZER (with medicines such as albuterol, proventil, ventolin, proair, or xopenex), have him/her USE IT IMMEDIATELY (for inhalers preferably with a spacer or valved holding chamber).



During an asthma attack an individual should:  

  • Prepare inhaler for use by shaking canister for several seconds. Exhale or empty all air out of lungs, and follow as listed below with or without a spacer: 
  • Inhaler With a Spacer or Holding Chamber: Inhale 1 puff of medication by depressing the canister once, breathe in slowly and deeply, hold breath for 10 seconds and then exhale.
  • Inhaler Without a Spacer or Holding Chamber: Place inhaler at the opening of the lips or a distance of 1 inch from open mouth; depress canister one time and inhale medicine quickly at the same time; hold breath for 10 seconds and then exhale.
  • Wait 30 seconds to 1 minute between puffs of inhaled medication.
  • Shake inhaler canister between puffs.
  • Repeat process, exhale all air from lungs, depress canister only once, inhale fully, hold breath for 10 seconds and then exhale.
  • Continue as needed, typically 4 to 8 puffs (depending on severity of symptoms).

Have the individual having the asthma episode sit up and slowly breathe in through the nose and out through pursed lips (pursed lip breathing). Pursed lip breathing technique is as follows:  

  • Start by sitting comfortably in a chair. Do not lie down. 
  • Relax your shoulders and neck. Concentrate on not gasping for air as you drop your shoulders.  
  • Breathe in slowly through your nose. Concentrate. 
  • Purse your lips together tightly as if trying to whistle, and blow out slowly through your mouth. Take as much time as possible to exhale in this way.  
  • Relax. Keep using the pursed-lip breathing until the breathless feeling goes away. Rest between breaths if you feel dizzy.

 Give sips of room temperature water.  

4. REPEAT above steps if symptoms continue.



  • Quick Relief (Rescue) Inhaled Medications known as bronchodilators such as Albuterol and Xopenex should provide relief of immediate asthma symptoms (wheezing, shortness of breath, coughing) within 5 to 10 minutes of use.
  • Per National Guidelines (NHLBI: EPR3) for “Home” management of asthma attacks – Up to two treatments (either by nebulizer or inhaler) 20 minutes apart may be administered, assessing condition throughout both treatments to determine if emergency transport/emergency department treatment is necessary. This guideline is for all age groups from infants to adults.



    CALL 911 IF:   


    YOU are not sure what to do – or

    • The Quick Relief Rescue medication is not working (symptoms are getting worse, not better) or, medications are unavailable – or

    • The person’s lips or fingernails are BLUEor

    • The individual is having difficulty talking, walking, or drinking liquids – or

    • The person’s nostrils are flaring out – or

    • You see neck, throat or chest muscle retractions – or

    • The person is in obvious distress, there is a change in level of consciousness, or the individual is showing signs of confusion – or

    • The individual’s condition is deteriorating.


    Printable version:  What to Do During an Asthma Attack


    Click on the following for additional information on medication names and types, dosages, and national guidelines for their use during an acute asthma attack episode. 

    List of Asthma Medications, Dosages, Usage, and NHLBI Guidelines EPR3 Referencing



    Note: You will need Adobe Reader (PDF) to view some of these documents.



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