Being on the right asthma treatment and avoiding known triggers greatly reduces the chances of an asthma attack. An attack may come on suddenly (for example in severe brittle asthma) but often there will be warning signs for a few days before.
People we talked to told us that warning signs included having to use the blue reliever inhaler more often, changes in peak flow meter readings, and increased symptoms, such as waking up coughing in the night. Warning signs should be taken seriously because they indicate that the asthma control is poor which increases the risk of having a severe attack. As Dee said, “You can manage to do an awful lot not to let it escalate into a really serious attack, and a serious attack is a big chunk out of your life. So it really motivates you to try to do everything you can not to let it happen.”
Many people have a personal asthma action plan to help them to know what to do when symptoms escalate, but if they continue to get worse further help may be needed.
Andreane made a personal asthma plan with a specialist asthma nurse. She works out when it’s time to ask for help by monitoring her peak flow and how often she is taking her reliever inhaler.
Often using the reliever inhaler will be enough to calm things down but sometimes symptoms may become more severe and the person may need to take further action and call for help, or go to an emergency department. In the event of a severe asthma attack current advice (Asthma UK 2016) recommends that you:
- Sit up straight – dont lie down. Try to keep calm.
- Take one puff of your reliever inhaler (usually blue) every 30–60 seconds, up to a maximum of 10 puffs.
- If you feel worse at any point while youre using your inhaler or you dont feel better after 10 puffs or you’re worried at any time, call 999 for an ambulance.
If the ambulance is taking longer than 15 minutes you can repeat step 2.
A specialist nurse describes an asthma crisis and when someone should seek medical advice.
We talked to people about asthma attacks, which were sometimes frightening (see What asthma feels like). Struggling or ‘fighting’ for air could make people feel panicky but, as Dee and Philip explained, an asthma attack is not the same as a panic attack.
Chris says the treatment and help that is available enables you to live a full life.. It’s terrifying to have it and it’s terrifying to watch it, but it passes.
Dee explains how she can feel both physical and psychological symptoms during an asthma episode. The aim of medication is to try to avoid getting to that point. [AUDIO ONLY]
Not everyone who has an asthma attack needs hospital treatment and it largely depends on the severity. Many people with asthma never need hospital care. Some may need it only once or twice in their lives and have managed attacks on their own, or with advice from their GP or asthma nurse. Susan remembered a couple of times when she had gone out without her inhaler and was at the point of feeling unable to cope, but she wasn’t far from home and managed to get back and use it in time.
Jane has had asthma for many years and keeps a supply of the oral steroid prednisolone at home to use when her asthma flares up, although she usually phones her GP for advice before she begins taking them. “I would take it when my asthma is bad and I’m vulnerable.”
A few people said they had misjudged the warnings, or not recognised the severity of their symptoms, and had ended up having a bad attack. Those who had a written action plan, or had discussed what they should do in the event of an attack with the GP or asthma nurse, were aware of how to keep control of their asthma.
Dee and others described finding it hard to make proper decisions during an attack, feeling “in a fog”, “detached”, not wanting to move, and “feeling or being past caring” what happened to them. Having written details of the medicines and emergency information could also be very useful for other people around, especially if the attack means that it is hard for the person to speak. If another person witnesses the attack they may be able to help take action on the person’s behalf. People we talked to suggested that it can be a good idea to warn friends, family and colleagues what to look out for and what to do, for example, just knowing where an inhaler is kept could be very helpful to someone who is struggling with an attack.
Philip describes a time when he had an asthma attack when he was at school and his dad took him to A & E. He felt he couldn’t move while it was happening.
Dee had her most severe attack during the night which she says is a time when it’s more difficult to make proper decisions because you are tired. At other times it’s easier to be more aware of your peak flow measurement and use that as a guide. [AUDIO]
Ann always makes sure she has her medication nearby because having a sudden onset of chest pain or being unable to breathe can be scary and she is often on her own at home. But she says she has never got to the point where she doesn’t know what to do next
A doctor explains how a person having an acute asthma attack is treated in hospital. This may include oral steroid tablets and using a nebuliser to get medication into the airways effectively. Some people may need to go to hospital.
Mary was hospitalised quite often when she was younger, but these days if she has an attack it can usually be dealt with at A&E and she can generally go home the same day. However, Mary, like Ann above, said she sometimes worried about being alone and not being able to get help.
Mary worries about having an attack in the middle of the night because she lives alone. [AUDIO ONLY]
Faisil remembers his mother calling for the doctor in the middle of the night when he was a child and he would be given an injection to calm things down, or she would take him to A&E where he’d be given oxygen. As an adult he has largely been able to control his asthma but there have been times when he’s gone to A&E and been given medication through a nebuliser, which usually works more quickly than using an inhaler.
Andreane said that when things are getting out of control it can be reassuring to have people around you who help you to stay calm. “Any form of kindness from a colleague or friend or a family member just you know, shows that they care and you know, they want to help you, helps a lot”.
Belinda remembers a time when she had been taken to hospital with severe breathing problems and the nurse had given her a nebuliser and stroked her back which she found helped her to calm down. Some people said that they made a point of making sure that other people such as airline staff or employers would know what to do in case of emergency.
Dee always uses her peak flow meter to keep a check on her lung function and when it’s low knows that she needs to step up her medication. She has only had to go to hospital for emergency help twice and says the best piece of advice she was given when she was first diagnosed was to be “an organised asthmatic”, which for her means keeping a note of her medication in a place where others would be able to find it, keeping inhalers in places like the car and the office drawer, and most importantly, using a peak flow meter regularly so that if her reading goes below a certain level she knows it’s time to get help. The time when she had to go to hospital for help she said “I misjudged how far down into breathing difficulties I was because I didn’t have a peak flow meter”. At the time she was away on holiday and out of her normal routine.
Being away from home in an unfamiliar environment, especially abroad, can be worrying for people with asthma, so planning ahead can be useful. (See Managing asthma: reviews and action plans).
Jane has had times in her life when her asthma has been very bad and she has been admitted to hospital, but she tries to avoid it. She can generally recognise when it’s time to get help.
Margaret has had some times when her asthma has gradually got worse and she has had to take more medication to get it under control, but she once had a serious attack and had to go to hospital.
David has occasionally had to go to the local GP surgery or drop in clinic to be given medication through a nebuliser. He recommends carrying an emergency card that tells other people how they can help you in the event of an emergency.
For some people with severe or brittle type asthma, hospital admissions are a more regular occurrence and difficult to avoid. Jenny has a type of asthma that is very unstable and she says she can have very little warning before an asthma attack. “I don’t have simple asthma, I have what’s called severe brittle asthma, which means I go from being perfectly well to terrible in a matter of hours – or I can do, but that’s not what all asthmatics do, and so I don’t, I don’t want to frighten all asthmatics and say, you know, ‘you’re all going to end up going blue round the edges’ because you’re not, but it’s just what I do.”
Jenny has severe brittle asthma and is often in and out of hospital. She recalls the first time she went in to A&E as an emergency, but now the hospital staff and paramedics know her and what she needs.
Jenny is often given aminophylline in hospital. This is a bronchodilator which is given in injection form, but it can have unpleasant side effects including vomiting. Mary is now able to get aminophylline at her GP surgery, which is much more convenient.
Jenny’s local ambulance service has a ‘red flag’ on her mobile phone number so that if she rings they know it’s her and she does not need to speak much. Her care is normally very efficient, but just occasionally she has had to wait in and A&E when staff have not been so well-informed about asthma. Others said their experiences had been mixed, with some excellent and immediate attention in A&E, but also some encounters with junior staff with limited experience and training who did not realise the need for urgency.
Jane (above) carries an emergency admission card to ensure she gets seen quickly, and the only time her care has been less good was when she was admitted for another condition. The nurses had no training in respiratory care and did not understand that she needed medication immediately in an attack.