Asthma Attacks: Symptoms and Causes

When asthma quickly gets worse, usually in response to a trigger - this might be called an asthma attack, acute asthma, a flare-up, or an exacerbation. While early symptoms can be mild, without early identification and treatment an attack can rapidly escalate to a life threatening attack 

Asthma attacks can happen in people who already know they have asthma. However, an asthma attack might also be the way someone finds out they have asthma for the first time.

An asthma attack may need urgent medical attention. It is crucial to know when an asthma attack is becoming an emergency, and what you need to do while you wait for help to arrive.

Once an asthma attack has settled, consultation with your GP for identifying and managing triggers of the attack becomes an important part of preventing future attacks.

Understanding Asthma Attacks

What is an Asthma Attack?

An asthma attack is when your lungs quickly get worse with asthma symptoms. These can be any of:

• Trouble breathing

• Coughing

• Tightness or discomfort in your chest

• Wheezing (noisy breathing)

Asthma attacks occur when airflow to your lungs becomes too tight (bronchoconstriction) and the lungs have too much swelling and mucus (inflammation). There is usually a combination of triggers for the asthma attack.

A worried parent

“Our 5 year old had just started school. We were used to the coughs and colds he brought home - but this last cough had lingered on for the last few nights.

We tried various things to settle the cough - an air purifier, a vaporizer from the pharmacy, vacuuming his bed, removing his stuffed toys. Nothing seemed to work.

One morning we received a calhl from his teacher. Our son was in sports and couldn’t stop coughing. He was telling them his chest hurt.  

We took him to this GP straight away, and that’s when we found out he was actually having an asthma attack. Our doctor started a puffer which settled his breathing. We wanted to make sure this didn’t happen again.” 

Olivia’s story

“I had been on top of my health since quitting smoking a few years ago. I was going for runs several times a week, and I felt so good that I hadn’t needed to fill out the script for my asthma puffer in ages. Things were going great.

At the start of Spring I found myself struggling to get through my usual runs. My hayfever had been playing up and things were quite stressful at work. I had also just recovered from a cold so I put this down to being run down. I kept pushing through my exercise routine to keep fit.

One morning I woke up and my chest felt so heavy and tight. I was having trouble even getting up the stairs to my house. My partner ended up calling an ambulance. That’s when I found out my oxygen was low, and I was actually having a severe asthma attack.”

How dangerous are Asthma attacks?

Asthma attacks can be life-threatening. In 2022, asthma caused 467 deaths in Australia (AIHW). Unlike regular symptoms, attacks can escalate rapidly, leading to hospitalisation or even death if not managed promptly. Repeated attacks may also cause long-term lung damage.

Symptoms of an Asthma Attack

Mild to moderate symptoms

Identifying asthma symptoms early and taking asthma medication according to your asthma action plan can prevent a severe attack.

Remember, symptoms of asthma are:

• Trouble breathing

• Coughing

• Tightness or discomfort in your chest

• Wheezing (noisy breathing)

You might also notice:

• You need to use your reliever puffer more often

• Your asthma medications aren’t working as well

• Waking up from asthma symptoms

• Asthma is affecting your daily activities

• Your Peak Expiratory Flow (PEF) meter readings worsening

• Worsening tiredness

Severe Symptoms

Severe asthma attacks can be life-threatening and require immediate medical attention. Call 000 immediately if you or someone experiences:

• Difficulty breathing (or poor effort breathing)

• Unable to speak more than a few words

• Bluish lips or face – A sign of dangerously low oxygen

• Needing to sit hunched forward, or difficulty lying flat

• Confusion or dizziness

• Collapse or exhaustion

• No improvement after using a reliever inhaler

Acting quickly can save a life. Always carry your medication, asthma action plan and inform those around you about what to do in an emergency.

Silent Asthma Attack

An asthma attack might not have coughing or wheezing. Instead, symptoms may include shortness of breath, chest tightness and extreme fatigue. 

Since it can progress quickly, it is vital to seek medical attention immediately if breathing becomes difficult.

Recognising Symptoms in Children

Children with asthma may not always express their discomfort. 

Signs parents should look out for include:

• Frequent coughing, especially at night

• Noisy breathing

• Low energy or difficulty keeping up with activities

• Fast breathing or sucking in the chest when inhaling

• Complaints of chest discomfort or pain

• Irritability or trouble sleeping

If these symptoms persist or worsen, consult a doctor to prevent a serious attack.

Causes and Triggers of Asthma Attacks

Common Triggers

Asthma attacks can be triggered by many things. Some of these are avoidable, while others are not. Your GP can help you work out what your asthma triggers are.

Cigarette smoke should always be avoided. If you are a smoker, your GP can help you with strategies and medications that can help with quitting.

Other potentially avoidable triggers can include:

• Allergens (pollen, dust mites, pet dander, mould)

• Smoke (cigarettes, bushfire smoke)

• Pollution and strong smells

• Cold air or weather changes

• Exercise-induced asthma (physical activity)

Unavoidable triggers can include:

• Exercise

• Laughter or extreme emotions

Infections

Colds, flu, and respiratory infections can worsen airway and lung inflammation. There are safe and effective vaccines that protect against influenza, pneumococcal, RSV and COVID-19, all of which can potentially trigger an asthma attack. In some cases the cost of these will be subsidised by the government. Your doctor can help you work out which would be most suitable for you.

Exercise

Physical activity can potentially trigger asthma (eg. as seen in exercise-induced bronchoconstriction). However, regular exercise is also important for long term asthma control and overall health.

Exercise should generally not be avoided in asthma, but it is important you speak with your doctor about preventing and managing asthma attacks due to exercise. For example, warming up before exercise and using a reliever inhaler beforehand can help prevent attacks.

In some cases, your GP may refer you to see an exercise physiologist to ensure your exercise regimen is optimal.

Medications

Sometimes certain medications (eg. aspirin, painkillers, heart or blood pressure medications) can trigger asthma. You need to discuss this with your doctor so that any medication can be safely changed if necessary.

In some cases your doctor may recommend a home medication review to work out whether one of your medications is triggering your asthma.

Chronic medical conditions

Living with other medical conditions, especially if they are poorly controlled, can also increase the risk of asthma attacks. These include:

• Allergic rhinosinusitis (“Hayfever” or “Sinus”)

• Gastro-oesophageal reflux disease (“GORD” or “Reflux”)

• Nasal polyps

• Obesity

• Upper airway dysfunction

Your GP may help coordinate a chronic disease management plan to help you manage and optimize these conditions so that they are less likely to trigger asthma attacks.

Physiological changes

Normal changes to your body can also be triggers for asthma. These include:

• Pregnancy

• Hormonal changes with the menstrual cycle or perimenopause

• Sexual activity

Managing an Asthma Attack

Immediate Steps to Take

 If you notice symptoms of an asthma attack, follow and take your reliever immediately, as well as any other medications as per your up-to-date asthma action plan, if you already have one.

During a severe asthma attack, staying calm and acting quickly is crucial. Here’s what you should do:

1. Sit upright and try to stay calm. Avoid lying down. Call for help immediately.

2. Take your reliever inhaler, depending on your prescription. Examples include:

• Salbutamol inhaler: 4 puffs, repeating again every 4 minutes if needed

• Terbutaline inhaler: 2 puffs, repeat 1 puff again every 4 minutes if needed

• Budesonide+Formoterol: 2 puffs, repeat 1 puff again every 4 minutes if needed

3. If symptoms persist, call 000 (in Australia) immediately and tell the operator there is an asthma emergency

If available, using a spacer maximizes the effectiveness of medication.

If you are unsure if you are having an asthma attack, or if your symptoms are not settling with asthma medication, you must seek urgent medical attention. 

Steps to take after an asthma attack has settled

Once the attack has passed, it is important to closely monitor your symptoms. Make sure you have your asthma medications with you at all times. Rest and stay hydrated, and make an appointment with your GP the same day if possible. Your GP will make sure you are on the right medications and have an updated asthma action plan. If treatment for life threatening asthma was needed, you will also need to see a specialist for ongoing care. Make sure you have a family member, friend or colleague to stay with you until you see your doctor.

When to Seek Emergency Help

Seek emergency care (call 000 for an ambulance) if the person:

• Is having any symptoms of severe asthma

• Has suddenly worsening symptoms

• Has asthma but does not have a reliever

• Is unsure if they have asthma

• Has a known allergy to food, medication or insect bites/stings

• Is not responding to asthma reliever medication 

Preventing Asthma Attacks

Long-term Management Strategies

Reducing asthma attacks requires a comprehensive approach and advice from your doctor. Key strategies include:

• Recognizing and treating early signs of worsening asthma control

• Using preventer medications regularly (as prescribed)

• Having a reliever on you at all times

• Avoiding and managing known triggers

• Managing other medical conditions associated with asthma attacks

• Keeping up to date with your vaccinations

• Maintaining a healthy lifestyle through regular exercise and a balanced diet

• Attending regular check-ups with your doctor to monitor asthma control

• Having an up-to-date asthma action plan

Your GP may recommend a chronic disease management plan to effectively coordinate these strategies.

Asthma Action Plan

An asthma action plan helps you manage asthma by outlining daily medication use, step-by-step emergency instructions, and personalised adjustments to treatment based on triggers and symptoms. 

Consult your doctor to develop a tailored asthma action plan.