Asthma attacks can cause distress, especially if you don’t feel prepared or confident to handle one. An asthma attack can cause the airway tubes in your lungs (bronchi) to tighten up, causing symptoms like coughing, wheezing, a tight feeling in the chest, and difficulty breathing.

This article discusses how you know you are having an asthma attack. You’ll learn what you should do if you have or don’t have your rescue inhaler, the type used to treat an immediate asthma attack. You’ll also learn how long to expect the attack to last and when to call a healthcare provider or seek emergency treatment.

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Asthma Attack Symptoms: How to Tell in the Moment

Sometimes your asthma symptoms will start after exposure to something you know triggers your asthma, like exercise, cold air, a viral infection, chemicals, smoke, perfume, pet dander, dust, or pollen. However, sometimes, the trigger isn’t apparent.  

If you’ve had asthma for a while, you probably know what an asthma attack feels like. It might start with coughing, and then you might begin to wheeze, making a whistling sound when you breathe. Your chest may feel tight, like something is pressing on it. 

You can have a hard time getting your breath. Some people describe it as feeling like the air is getting sucked out of them or trying to get all their air through a straw. Difficulty getting air in could cause you to feel light-headed. Many people have mild symptoms that are bothersome but treatable.

Severe Attack Symptoms

Severe attacks are more serious. In a more severe attack, you may have such difficulty breathing that it becomes challenging to complete a sentence. People with more severe attacks may also have symptoms such as:

  • Heavy sweating
  • Nausea
  • Confusion
  • Blue or gray skin

If this happens, seek immediate medical attention.

Quiet Asthma Attack

Sometimes a person with a severe asthma attack might not move enough air through the lungs to cough or wheeze. A quiet attack can be serious and potentially life-threatening.

Asthma Attack Without Inhaler: What to Do

Ideally, you’ll always have a rescue inhaler around to use if an asthma attack happens. However, even if you don’t have an inhaler, you can take steps like the following to help resolve the attack:

  • Remove triggers: An essential first step is removing yourself from potential triggers. If you are exercising in the cold air, stop and come inside. Or if you think a chemical or perfume might have triggered it, leave the area. 
  • Stay calm: Try to remain calm. This may be easier said than done since an attack can be emotional and frightening, but anxiety may make the attack worse. Do whatever makes you feel centered, like listening to music. 
  • Sit upright: You want to allow your lungs to expand. This works better than lying down or hunching in a chair, but being off your feet is better. 
  • Breathe slowly: Focus on not breathing too quickly. Breathing through your nose may work better than through your mouth. 
  • Get help: Make sure you have a way to get help if needed. If someone is nearby, alert them to the situation and have them keep an eye on you. If you are alone, find a phone, and don’t hesitate to call 911 if your symptoms are severe.

It may help to drink a beverage with caffeine, like tea or coffee. Caffeine is closely related to a compound sometimes used to treat asthma (theophylline).

Asthma Attack With Inhaler: What to Do

If you have an asthma attack and your rescue inhaler is available, use it immediately. The medication you inhale opens up the bronchi in your lungs, allowing you to breathe more easily. Unlike other medicines you might take for asthma, you should only use the rescue inhaler if you have an attack.

Ideally, you’ll already have read the instructions that came with your inhaler or talked with a healthcare professional about administering it. 

The specifics of giving yourself the inhaler may vary based on the type of medication and the healthcare provider’s instructions. It’s best to use an inhaler attached to a spacer, a space connecting the inhaler medication and the mouthpiece. This helps you breathe the medicine more effectively. 

However, as a general rule, you should do the following:

  • Prime the inhaler if it’s been more than a couple of weeks since you’ve used it. This involves spraying the inhaler away from your face about three times.
  • Take the caps off your inhaler and your spacer. 
  • Ensure there isn’t anything inside the mouthpiece, and shake the inhaler about 10 to 15 times.
  • Breathe out as much as you can, holding the mouthpiece down.
  • Form a tight seal around the mouthpiece. Slowly breathe in through your mouth as you press down once on the inhaler canister. 
  • Take the inhaler out of your mouth. Hold your breath for as long as you can, up to 10 seconds, to help get the medicine deep into your lungs. 

The medical professional who prescribed the inhaler for you should have given you instructions about how frequently you can use the inhaler. For some medications, you can repeat this process immediately, starting with shaking. For others, like albuterol, you should wait one minute before repeating the sprays. 

Rinse your mouth with water after using your inhaler, and spit it out afterward to reduce potential medication side effects.

The approach of removing triggers, staying calm, breathing slowly, and sitting upright also applies to people who have a rescue inhaler available.

Other Rescue Therapies

Not everyone uses an inhaler for their rescue asthma treatment. Another option is a nebulizer, which turns the liquid medicine into a mist you can inhale through a face mask.

After your initial rescue treatment, follow your healthcare provider’s instructions about follow-up with additional treatment. For example, if your symptoms are still significant after an hour, they might have prescribed you to use a different type of rescue inhaler, a rescue nebulizer treatment, or an oral steroid.

4:4:4 Rule

You can use the 4:4:4 rule to remember how to handle an asthma attack. After sitting upright, take four separate puffs on their inhaler. If you haven’t improved after four minutes, take another four puffs. If there is still no improvement, get emergency help. Keep delivering four puffs every four minutes, up to the limit your specific medication allows. 

When Do Asthma Attack Symptoms Stop?

When an asthma attack stops can vary based on the length and severity of airway inflammation. After a mild episode, symptoms might go away within minutes, sometimes spontaneously. Other times they resolve within a few minutes after using a quick-acting inhaler. However, you might feel the lingering effects of more severe attacks for hours or even days.

If Symptoms Don’t Stop

If symptoms aren't starting to improve after 20 minutes of using a rescue inhaler, seek emergency medical care. If you have moderate symptoms that still haven't gone away after 24 hours, call a healthcare provider.

Asthma Attack Not Ending: When to Get Emergency Care

Some people need to get emergency care for an asthma attack. It’s imperative if the person has previously experienced a potentially fatal asthma attack known as status asthmaticus.

Always seek assistance if you have any doubts, but the following situations might increase the need for emergency care:

  • At-home rescue inhalers haven’t fully resolved the asthma attack, and you can’t perform your usual activities.
  • The attack was severe and came with symptoms like sweating, faintness, nausea, a rapid pulse, and pale skin. 
  • You are still straining to breathe and have persistent shortness of breath and chest tightness, even while lying down.
  • You were hospitalized for asthma in the previous year.
  • You have had life-threatening asthma attacks in the past.
  • You have not been following your asthma treatments.
  • You have a mental health or substance abuse disorder.
  • You are hunching your shoulders or straining your neck muscles to get enough air. 

If you or someone you care for is showing any life-threatening signs that don’t quickly resolve, get emergency care immediately—don’t wait for a healthcare provider to call you back. Emergency symptoms include fingernails or lips turning blue or gray, severe difficulty breathing, confusion, or decreased consciousness.

At the emergency room, they can use treatments given through a nebulizer or intravenous (IV) line in your vein. They could also provide oxygen or breathing support through a ventilator if needed.


The shortness of breath, chest pain, cough, and wheezing from an asthma attack can be scary to experience or watch. However, knowing how to handle a potential attack can make you feel more confident and in control. 

Ideally, people with asthma should always have a rescue inhaler handy to treat an attack effectively and quickly. Talk to your healthcare provider about how and when to use this inhaler. But even if you don’t have one, you might help resolve your attack more quickly by breathing calmly and deeply.

Asthma attack symptoms sometimes resolve quickly, but other times they may take longer. Some people even need emergency treatment. Don’t hesitate to get help for potentially life-threatening symptoms like severe difficulty breathing or blue or gray skin. 

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