Symptoms, Causes, Treatment, and More

An asthma attack, or flare-up, is the worsening of asthma symptoms in response to a trigger, such as an allergen, intense exercise, or an upper respiratory infection.

These triggers cause the muscles surrounding the airways to tighten or spasm and lead to excess mucus production in the airways, making it difficult to breathe. Symptoms of an asthma attack—like coughing, shortness of breath, wheezing, and chest pain or tightness—can range from mild to severe. 

About 25 million people in the United States have asthma, and more than 10 million reported experiencing at least one asthma attack in the past year. An asthma attack always requires prompt treatment to prevent life-threatening complications. Treatment varies from person to person but typically includes medications that reduce airway restriction and inflammation.

Symptoms of an asthma attack may develop gradually or happen suddenly and can vary from person to person. Mild asthma attacks may last a few minutes, while moderate to severe asthma attacks can last for hours or days. 

Early Warning Signs of an Asthma Attack 

Asthma attacks sometimes begin with subtle symptoms that you may notice before more intense and obvious asthma symptoms develop. Recognizing these early warning signs and taking action can help prevent a full-blown asthma attack.

Common early signs and symptoms of an asthma attack include: 

• Increased mucus production in your airways 
• Runny, stuffy, or congested nose 
• Unusual fatigue, tiredness, or weakness 
• Itchy chin or neck 
• Inability to take a deep breath 
• Sharp, sudden, or persistent cough 
• Tickle in your throat or chest 
• A drop in peak flow readings (if you use a peak flow meter)
• Tense, raised shoulders (closer to your ears) or slouching posture 

Mild To Moderate Asthma Attack Symptoms

It’s important to act promptly during a mild to moderate asthma attack. These attacks cause symptoms that require quick-relief medications, such as an albuterol inhaler, to prevent symptoms from worsening.

During a mild to moderate asthma attack, you might experience:

• Wheezing, a whistling sound when breathing
• Chest tightness or discomfort
• Cough that may worsen at night or during physical activity 
• Shortness of breath or feeling like you can’t get enough air 
• Retractions, meaning your ribs pull in as you inhale 
• Neck muscle strain or tightness as you work harder to breathe

Severe Asthma Attack Symptoms

A severe asthma attack is a life-threatening emergency and requires immediate medical attention. During a severe asthma attack, your airways are so swollen and inflamed that it may be too difficult to speak, stand, or walk.

Symptoms of severe asthma attacks include:

• Severe shortness of breath
• Rapid breathing (short, shallow breaths) 
• Retractions, with the skin around the neck, chest, and rib bones sinking in as you inhale 
• Hunched over shoulders and posture 
• Chest pain that may feel like a heavy weight is sitting on your chest 
• Bluish tint to your lips and fingernails 
• Drowsiness or confusion as your body and brain struggle with oxygen deprivation

Asthma is a chronic condition that can cause inflammation in the bronchial tubes, the airways that carry air in and out of the lungs. An asthma attack occurs when a trigger causes changes in the airway that obstruct normal airflow and make breathing difficult. 

During an asthma attack, the muscles surrounding the airway constrict (tighten) or spasm, narrowing the airways. This constriction, combined with airway inflammation and increased mucus production, makes it harder to move air in and out of your lungs, causing the hallmark symptoms of an asthma attack. 

Asthma Attack Triggers 

What triggers an asthma attack varies from person to person, but common triggers include: 

• Allergen exposure: Allergens are substances such as pollen, dust mites, pet dander, and mold that can cause an allergic reaction in people with allergies.
• Irritants: Exposure to certain chemicals, dust, and fumes—including cigarette smoke, air pollution, strong odors, and wood fires—can trigger asthma attacks. 
• Weather: Cold air, high humidity, dry wind, and rapid temperature changes can trigger an asthma attack.
• Respiratory infections: Viral and bacterial upper respiratory infections can increase airway inflammation and mucus production and increase the likelihood of experiencing an asthma attack. 
• Exercise: Intense physical activity that makes you breathe harder and faster can trigger asthma attacks in some people. 
• Emotions: Stress, anxiety, and intense emotions—even positive ones like joy and laughter—can cause breathing changes and trigger an asthma attack. 

If you already have an asthma diagnosis, diagnostic testing is not always necessary for an asthma attack. You may require emergency medical care if your symptoms do not improve with treatments at home. 

Even if you don’t require emergency care, your healthcare provider may want to see you to evaluate the severity of the attack, monitor your symptoms, and assess your lung function and response to treatment. They may run tests, including:

• Peak flow meter: A peak flow meter is a small device you blow into as hard and fast as possible to measure how well air moves out of your lungs. Peak flow readings can help detect asthma attacks before symptoms begin and indicate when you need quick-relief medications to open your airways. 
• Spirometry: This test evaluates your lung function by measuring how much and how quickly you can exhale forcefully after taking a deep breath.
• Pulse oximetry: For this, a device is clipped onto the end of your finger. The tool measures oxygen saturation in your blood and determines how well your lungs are delivering oxygen to the body’s tissues. 
• FeNO test: As you blow into a mouthpiece connected to a machine, the machine measures the nitric oxide level in your exhaled breath. High nitric oxide levels indicate swelling and inflammation in the lungs.

Treating an asthma attack aims to reduce airway inflammation and open the airways to relieve symptoms and restore normal breathing. Depending on the severity of the asthma attack, this may include at-home treatments and/or emergency medical care. 

Asthma Action Plan 

Most people with asthma develop an asthma action plan outlining how to control their asthma. This personalized plan, developed with the support of a healthcare provider, outlines steps to take when symptoms worsen or an asthma attack occurs, including information about: 

• What triggers your asthma symptoms 
• How and when to take your daily and quick-relief medications
• What to do when symptoms worsen and when to seek medical attention

At-Home Asthma Attack Treatments 

It’s essential to use your at-home asthma treatments at the first sign of an asthma attack or worsening symptoms. At-home treatments are usually enough to manage symptoms of mild to moderate asthma attacks and may include: 

• Sitting up straight and staying calm: An asthma attack can be a scary experience. When symptoms worsen, try to keep calm and sit up straight to open the airways and make it easier for air to reach your lungs.
• Using quick-relief inhalers (bronchodilators): Quick-relief (rescue) inhalers contain medications that relax airway muscles, open the airways, and improve breathing. Rescue inhalers typically contain short-acting, beta 2-agonist drugs (SABAs), such as ProAir (albuterol), or anticholinergic bronchodilator drugs, such as Atrovent (ipratropium bromide) or Spiriva Respimat (tiotropium bromide).
• Taking oral corticosteroids: If asthma symptoms persist after using your quick-relief inhaler, it may be necessary to take inhaled or oral corticosteroids to reduce airway inflammation. 

Severe Asthma Attack Treatments

If you experience a severe asthma attack that does not respond to home treatments, emergency care is needed. Call 911 or go to the nearest emergency room. Depending on the severity of symptoms, emergency treatment for an asthma attack may include: 

• Oxygen therapy: If blood oxygen levels are low, supplemental oxygen can help ensure the body gets enough oxygen while you receive other treatments. 
• Bronchodilators: These are medications that open the airways and relieve breathing difficulties. You may use an inhaler or receive the medicine through a nebulizer, which delivers a continuous dose of the medication through a mask or mouthpiece. 
• Corticosteroids: Oral or intravenous (IV) corticosteroids reduce airway inflammation and swelling, helping open the airways and ease breathing.
• Heliox: A mixture of helium and oxygen may help air move through the airways and lungs to improve breathing and prevent intubation when other treatments are ineffective. 
• Noninvasive positive pressure ventilation (NIPPV): NIPPV uses gentle air pressure to open the airways and prevent intubation. 
• Intubation: In severe cases, when blood oxygen levels are low and other treatments are ineffective, intubation and mechanical ventilation can support breathing. Intubation involves inserting a tube into your trachea (windpipe) to help you breathe. The tube connects to a ventilator, a machine that pushes air in and out of the lungs. 

The key to preventing asthma attacks is keeping your asthma under control. To prevent asthma attacks, you can: 

• Avoid triggers: Identify and limit your exposure to triggers that worsen your asthma symptoms. Keeping a journal or log of allergens, weather events, or activities that trigger your symptoms can help you identify and avoid these triggers. 
• Follow your treatment plan: Take your asthma medications as directed by your healthcare provider to reduce airway inflammation and prevent flare-ups. 
• Use a peak flow meter: Monitoring airway inflammation with an at-home peak flow meter can alert you to worsening inflammation in your airways and help you identify when to use your quick-relief inhaler before symptoms develop. 
• Manage stress: Stress can worsen asthma symptoms and trigger asthma attacks. Practicing stress management techniques, such as mindfulness meditation, yoga, or breathing exercises, can help manage stress and lower the risk of stress-induced asthma attacks.
• Regular exercise: Physical activity can improve lung function. If intense exercise triggers asthma symptoms, consider low-impact exercises like walking, cycling, or yoga. 

Untreated asthma attacks can lead to serious, life-threatening complications. These include: 

• Hypoxia: Prolonged breathing difficulty can lead to insufficient blood oxygen levels. Low blood oxygen levels can prevent enough oxygen-rich blood from reaching the body’s organs and tissues, leading to organ damage. 
• Acute severe asthma: This is a severe, prolonged, potentially life-threatening asthma attack that does not respond to usual treatments and requires emergency care and hospitalization to prevent respiratory failure. This type of attack used to be called status asthmaticus. 
• Pneumothorax: During a severe asthma attack, air can get trapped in the airways and overinflate the lungs, leading to a collapsed lung.

Asthma attacks are sudden flare-ups of asthma symptoms, such as wheezing, coughing, and shortness of breath, that occur when the airways narrow, making breathing difficult. An asthma attack can develop in response to a trigger, such as allergen exposure, respiratory infections, strenuous exercise, intense emotions, and certain weather conditions. 

All asthma attacks require prompt treatment to control symptoms and prevent complications. You may be able to manage mild to moderate asthma attacks at home with your quick-relief inhaler and oral corticosteroids. More severe asthma attacks require emergency medical attention and treatment. 

Keeping your asthma well-controlled by following your treatment plan, avoiding asthma triggers, and regularly monitoring your lung health with regular checkups and at-home monitoring with a peak flow meter can help reduce the frequency and severity of asthma attacks.

Talk to your healthcare provider if you are experiencing an increase in asthma symptoms or more frequent asthma attacks. They can work with you to adjust your treatment plan if necessary.