An asthma attack represents a sudden worsening of asthma symptoms resulting from a specific physiological response within the lungs. This event is characterized by three simultaneous changes: the muscles surrounding the airways constrict (bronchospasm); the lining of the bronchial tubes swells due to inflammation; and thick mucus production increases. These combined factors severely narrow the air passages, limiting airflow. An asthma attack is a serious medical event that makes breathing difficult and can be life-threatening if not addressed promptly.
Observable Signs and Sounds
The physical and auditory signs of an asthma attack make the event immediately recognizable. The most distinct auditory sign is wheezing, a high-pitched, whistling sound produced as air is forced through the narrowed airways. This sound is typically more noticeable when the person breathes out, though it can occur during inhalation as the attack progresses.
A common sign is persistent, often dry, coughing, which represents the body’s attempt to clear the obstructed airways. This is accompanied by shortness of breath (dyspnea), which can feel like an inability to draw a full breath or a heavy weight pressing on the chest. The person may also exhibit rapid, shallow breathing as they struggle to take in sufficient air.
Observable physical changes include signs of respiratory distress, such as the use of accessory muscles in the neck and chest to aid breathing. A person may adopt a hunched-over posture, leaning forward to maximize lung capacity. The skin of the chest and neck might visibly pull inward with each breath (retractions), indicating the increased effort required to move air.
Recognizing Attack Severity
Differentiating the severity of an asthma attack is essential because it dictates the urgency of the response. Mild or moderate attacks usually allow the person to speak in full sentences, although they may feel breathless when active or speaking. During a moderate attack, the person may rely on their quick-relief inhaler, but the relief may not be complete or long-lasting.
Signs that an attack is severe or life-threatening require immediate emergency medical attention. A person experiencing a severe crisis will struggle to speak more than a few words at a time or complete a full sentence in one breath due to extreme breathlessness. Their respiratory rate can become elevated, and they may show signs of exhaustion.
In the most severe cases, a person may exhibit cyanosis, where the lips or fingernails take on a bluish or grayish tint, indicating low oxygen levels in the blood. Confusion or drowsiness can also occur, signaling poor oxygen delivery to the brain. A “silent chest” is an ominous sign where wheezing suddenly disappears despite severe breathing difficulty, suggesting a near-complete blockage of the airways and a lack of air movement.
Immediate Steps During an Attack
Once an asthma attack is recognized, quick action is necessary to stabilize the person’s breathing. The first step is to help the person sit upright, as this position allows for better lung expansion than lying down. The person should be encouraged to remain calm, since anxiety can worsen breathing difficulty.
Next, the person should use their quick-relief inhaler, typically a bronchodilator like albuterol, following their personal asthma action plan. If no plan is available, a common protocol involves taking one puff of the inhaler every 30 to 60 seconds, up to a maximum of 10 puffs. Using a spacer device with the inhaler helps ensure the medication reaches the lungs effectively.
If symptoms do not improve within a few minutes after using the quick-relief medication, or if severe crisis signs like cyanosis, confusion, or inability to speak are present, emergency medical services must be called immediately. Continuous monitoring of the person’s breathing and responsiveness is necessary until professional help arrives. The quick-relief inhaler can be repeated every four minutes if symptoms remain severe.