Asthma attacks: symptoms, triggers, and management

An asthma attack occurs when the airways in your lungs become inflamed, swollen, and narrowed, making it difficult to breathe. This happens because the muscles around the airways tighten and excess mucus is produced, further blocking airflow. During an attack, you may get symptoms such as wheezing, chest tightness, and shortness of breath.

Unlike other conditions that affect breathing, such as bronchitis or pneumonia, an asthma attack is often triggered by specific factors like allergens, cold air, exercise, or stress. For people with asthma, these triggers cause a sudden and intense reaction in the airways, which can quickly get worse if not treated right away.

Asthma attacks can vary in severity from mild to life-threatening. Although they can be scary, they can often be managed effectively with the right preparation and treatment.

Recognising the symptoms of an asthma attack early can help you respond quickly and effectively, preventing the situation from worsening. Symptoms can range from mild to severe, so it’s important to understand the differences. It’s also important to know that asthma attack symptoms can build up gradually or happen very suddenly.

Mild symptoms include:

• a feeling of tightness or narrowing in the chest
• mild shortness of breath
• a dry, persistent cough
• slight wheezing or a whistling sound when breathing

Mild asthma attack symptoms can often be improved by using a reliever inhaler.

Moderate symptoms include:

• increased difficulty breathing, making it harder to complete everyday activities
• louder or more frequent wheezing
• persistent coughing, especially at night or during exercise
• noticeable fatigue caused by reduced oxygen intake

If your asthma attack symptoms do not go away or get worse after using your reliever inhaler, contact your GP or asthma nurse for urgent advice.

Severe symptoms include:

• severe shortness of breath, even when sitting still
• inability to speak in full sentences due to difficulty breathing
• blue lips or nails (cyanosis), caused by low oxygen levels
• a rapid pulse or feeling lightheaded
• severe wheezing – you may also have no wheezing at all and this is called ‘silent chest’ which can happen when an asthma attack is extremely severe

If you or someone else is experiencing these severe symptoms, call 999 right away.

Here's what to do if you or someone else is showing signs of having an asthma attack:

Step 1: Stay calm and sit upright

1. Sit in an upright position to help open your airways. Avoid lying down, as this can make symptoms worse.
2. Try to stay as calm as possible since stress and panic can make breathing more difficult.

Step 2: Focus on breathing techniques

1. While getting your reliever inhaler ready, breathe in slowly and deeply through your nose, then out through your mouth.
2. If breathing feels difficult, try the “pursed-lip” technique – breathe in normally and exhale slowly through pursed lips, like you're blowing out a candle.

Step 3: Use your reliever inhaler

1. Take 1 puff of your blue reliever inhaler (usually Ventolin or salbutamol), every 30 to 60 seconds, up to a maximum of 10 puffs.
2. If you have one available, use a spacer to ensure the medication can reach your lungs more effectively.

Step 4: Call 999 for emergency help

1. If your inhaler is not improving your symptoms after 10 puffs, or you feel worse and get symptoms such as struggling to speak, blue lips or nails, or feeling drowsy, you or someone else must call 999 straight away.
2. Stay on the line with the emergency operator if you can, and follow their instructions until help arrives.

Step 5: Wait and repeat

1. Wait 10 minutes and then repeat the inhaler steps in Step 3 again, up to a maximum of 10 puffs.
2. If the ambulance has not arrived after using your inhaler up to 10 times, call 999 again if you are not still on the phone with an operator.

Always follow up with your doctor

After an asthma attack, it’s important to see your GP or asthma nurse as soon as possible to review your treatment plan (within 48 hours is recommended). If you go to the hospital for treatment, a doctor or nurse at the hospital may also do this with you, however, it’s still important that your GP knows about your most recent asthma attack and any changes to your asthma plan. They may suggest revisions to your treatment plan or changes in medication to prevent any further asthma attacks.

Having an emergency plan in place and carrying your reliever inhaler at all times can help you act quickly during an asthma attack and reduce the risk of complications.

Asthma attacks can be triggered by everyday scenarios, such as exercising or by triggers that irritate or inflame the airways. Recognising these triggers and taking steps to manage them can reduce the risk of an attack.

Common triggers

Allergens

Pollen, dust mites, pet skin flakes, and mould can trigger attacks in people with allergic asthma. To reduce the chance of this, we recommend:

• keeping windows closed during high pollen season
• cleaning your home regularly to avoid hair and dust buildup
• using hypoallergenic bedding and vacuum cleaner if you're not already
• using an air purifier

Cold air

Breathing in cold or dry air can irritate the airways. Wearing a scarf or mask over your mouth and nose during colder weather can help reduce this irritation. If you have a dehumidifier at home, be aware of using it too regularly or being in the same room for too long.

Exercise

Physical activity can also trigger asthma symptoms, especially in cold or dry conditions. We advise warming up before exercising and carrying your reliever inhaler to minimise risks of an attack. Your doctor may recommend taking an inhaler 10 to 20 minutes before you take part in exercise, so if you notice exercise is a trigger for you, speak to your doctor so they can update your treatment plan.

Stress

Stress and anxiety can make breathing problems worse and sometimes trigger asthma attacks. Practising relaxation techniques such as deep breathing or mindfulness can help you to better manage stress levels. If you have anxiety or panic attacks that make your asthma symptoms worse, speak to your GP about therapies that can help.

Infections

Viral infections, such as the common cold or flu, can irritate and inflame your airways. You can reduce your chance of an asthma attack caused by illness by:

• getting your seasonal flu jabs (which are free on the NHS if you have asthma and need a steroid inhaler)
• washing your hands regularly,
• taking steps to boost your immune system overall, such as eating well and taking vitamin D supplements, especially in the winter months

Strong smells and chemicals

Cigarette smoke, strong perfumes, scented candles, paints, and cleaning products can irritate your airways. Sometimes, these environmental factors cannot be controlled, but you can minimise this risk by:

• wearing a mask while using strong chemicals and cleaning
• ensuring there is good airflow in the space where you are using strong chemicals
• using natural alternatives where possible
• asking people in your household to not light scented candles or spray scented products in shared spaces

Less common triggers

Weather changes

Rapid changes in temperature, humidity, or air pressure can also cause an asthma attack on some occasions. It can be difficult to predict and plan for weather changes, so it's best to carry a reliever inhaler with you at all times.

Medications

Certain medications can sometimes make asthma symptoms worse and lead to an attack, such as:

• beta-blockers
• aspirin
• non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen

If you're currently taking these medications or are unsure about whether a different medication can affect your asthma, speak to your doctor.

It's important to note that although you may have an idea of what usually triggers your asthma, sometimes an attack can happen at random, and be triggered by something unexpected. However, taking the right steps to manage your symptoms can help you to minimise these risks. You may also want to keep an asthma diary while figuring out your triggers, as this can help you spot what could be making your symptoms worse.

Here, we explain the best treatments to use when you're having an asthma attack vs. preventative treatments that are designed for long-term use.

Acute treatments

Reliever inhalers

In most cases, blue reliever inhalers like salbutamol work quickly to relax airway muscles and restore normal breathing during an asthma attack. Usually, they work immediately to soothe asthma attack symptoms.

Nebulisers

In more severe cases, nebulisers are used to deliver medication (usually salbutamol) in a fine mist, helping to open the airways more effectively. These are only used in medical settings during emergencies.

Prednisolone

If you need to visit the hospital because of an asthma attack, you’ll be prescribed a course of prednisolone (at least 5 days) alongside your usual preventer inhaler. This is a type of steroid medicine that reduces inflammation in your airways and may help prevent a further asthma attack. An alternative will be provided if you cannot take prednisolone.

Emergency medications

If you have a severe asthma attack, you may also be given other types of medications to open up your airways, such as:

• an oxygen-driven nebuliser (medication that is given in a fine mist alongside oxygen)
• intravenous (IV) beta-2 agonists, such as salbutamol or terbutaline

Preventative treatments

Preventer inhalers

Steroid-based inhalers, such as Clenil Modulite or Soprobec, reduce airway inflammation and sensitivity when used daily, lowering the chance of attacks.

Where asthma is poorly controlled with a steroid preventer inhaler, a long-acting bronchodilator may be used. This is a type of medication that relaxes the muscles in the lungs and widens the airways, and because it’s long-acting, the effects can last for at least 12 hours. Symbicort Turbohaler contains the long-acting bronchodilator formoterol alongside a steroid.

Oral corticosteroids

Short courses of steroid medication like prednisolone may be prescribed to control severe inflammation during or after an attack. Long-term use is not recommended due to potential side effects, like weight gain and high blood pressure.

Leukotriene receptor antagonists (LTRA)

LTRAs usually come as an oral or chewable tablet that you take alongside your preventer inhaler. They block the action of leukotrienes, a substance released in response to an asthma trigger that worsens inflammation and mucus secretion. They are often prescribed for mild asthma to stop it from getting worse and the most common LTRA is montelukast (Singulair).

Biologic therapies

For severe asthma that does not respond to other treatments, biologic therapies target specific parts of the immune system to control symptoms. These are usually prescribed by specialists.

➤ Learn more about types of inhalers or get a more detailed overview of treatment options on our asthma treatments page.

If you’re unsure about the right treatment for your asthma, speak to your doctor. You can also explore ZAVA’s online services to request inhalers and manage your asthma more easily.

Though asthma attacks cannot always be prevented, you can significantly reduce your risk of an attack with the following tips:

These strategies should help you to effectively deal with asthma symptoms or flare-ups. If you’re unsure about any aspect of your asthma management, speak to a healthcare professional for personalised advice.

If you're looking after an older person with asthma, it can be helpful to be aware of the early warning signs and treatment options in different groups. We’re sharing tips on how to care for vulnerable people.

Asthma attacks in older adults

Recognising early warning signs in elderly adults

In older adults, asthma attacks may present differently and can be confused with other conditions like chronic obstructive pulmonary disease (COPD) or heart failure. Warning signs include:

• increased shortness of breath during normal activities like eating
• tiredness or weakness after small amounts of physical effort
• persistent coughing or chest tightness

When to seek medical help

Call 999 immediately if the individual:

• has severe difficulty breathing or speaking
• appears confused or drowsy
• shows cyanosis (blue lips or nails)
• does not respond to their reliever inhaler

Tailoring treatments for older adults

Older adults may need spacers to use their inhalers effectively. Regular check-ups are essential to ensure that their inhalers are working as intended, especially if arthritis or other conditions affect their ability to use them.

Monitor for potential side effects of asthma medications, such as tremors or an increased heart rate, and always consult a doctor if these occur.

Always consult a healthcare professional if you have concerns about treatment or care. Some older adults may need the help of a carer who visits once a day to help with administering medications like inhalers.

If you experience an asthma attack during pregnancy:

- Use your reliever inhaler immediately to relieve symptoms.

- If symptoms persist or get worse, call 999 or go to A&E for urgent medical assistance.

Untreated asthma attacks can pose risks to both mother and baby, so it’s vital to act quickly.

It's important to try and avoid your known triggers where possible and schedule regular checkups with your GP. Let your doctor know straight away if your symptoms become worse over time or if you have any other concerns.

When you're pregnant, hormonal changes can sometimes affect asthma symptoms. Some pregnant women notice that their symptoms get worse, while others experience no change or even an improvement.

When to get help

Contact your GP or midwife if you notice:

• your asthma symptoms are worsening or not responding to your inhaler
• you’re feeling unusually breathless during daily activities
• you have concerns about how your asthma might affect your baby

Safe asthma treatments during pregnancy

Inhalers like salbutamol are safe to use during pregnancy and help to provide fast relief from symptoms. Daily use of steroid-based preventer inhalers, such asClenil Modulite or Symbicort, are also considered to be generally safe.

When you find out you’re pregnant, speak to your GP or asthma nurse as soon as possible to review your asthma treatment plan. You should also let your midwife know that you have asthma.

Managing asthma attacks effectively begins with understanding the symptoms, identifying your triggers, and having a clear plan in place. Whether it’s using your reliever inhaler during an attack, taking daily steps to prevent symptoms, or knowing when to seek emergency help, every action you take contributes to better control of your asthma.

Asthma can be unpredictable, but with the right treatment, tools, and support, you can reduce the chance of attacks and live with asthma confidently. If you’re ever unsure about your symptoms or treatment, don’t hesitate to consult a healthcare professional. At ZAVA, we’re here to provide trusted advice and access to the medications you need to manage your asthma.