Topic Overview

An asthma attack (also called an acute asthma episode, flare-up, or exacerbation) is a sudden increase in the symptoms of asthma, including:

• Rapid, shallow, and difficult breathing.
• Feeling that you cannot take a deep breath (chest tightness). Children with chest tightness may complain of a stomachache.
• Whistling noises when breathing (wheezing).
• Coughing.

The symptoms may be mild, moderate, or severe, depending on how much the airflow to the lungs is reduced. Attacks can be brief (about an hour) or last for several days. They may be seasonal (similar to hay fever) or occur during any season.

Asthma symptoms may start suddenly or up to several hours after you or your child has been exposed to triggers, such as tobacco smoke or animal dander. In some cases (such as with asthma that happens during your job), symptoms may not occur until 4 to 12 hours after contact. Although severe attacks may seem to occur suddenly, they usually occur after several days of increasing symptoms.

Asthma attacks are caused by:

• Long-term (chronic) inflammation in the tubes that carry air to the lungs (bronchial tubes). Inflammation leads to overreaction (hyperresponsiveness) of the tubes to triggers.
• Tightening of the smooth muscles in the bronchial tubes, causing the airways to become smaller. This reduces airflow in and out of the lungs.
• Extra mucus produced by the mucous glands in the bronchial tubes. This can occur in some people with asthma and can interfere with airflow.

Although attacks can be serious, they can usually be treated at home. Many people have an asthma action plan, which is a written plan that tells you what medicine you need to use, based on the severity of the attack, and when you should call a doctor or seek emergency treatment. You and your doctor create the action plan.

The best strategy for avoiding and treating asthma attacks is being able to recognize an attack and know what to do. When creating an asthma action plan, be sure to talk to your doctor about:

• Asthma triggers. The triggers are substances (such as pollen or cigarette smoke) that can cause an attack. Avoiding triggers can help decrease the risk of an attack and reduce its severity.
• Asthma symptoms. These generally include a drop in peak expiratory flow (PEF) and increased and more severe coughing, wheezing, shortness of breath, and tightness in the chest. The symptoms may vary between people.
• Which quick-relief medicines you or your child needs to take and how to take them.
• How to evaluate whether the quick-relief medicines are working.
• When emergency care is needed. If the person with asthma has a large drop in PEF, finds that quick-relief medicines are not working, or notices that the skin has a bluish color, he or she may need emergency care. Your doctor will help determine these signs.