If you have asthma your airways are chronically inflamed. An asthma attack is triggered by a series of respiratory changes including:

• Tightening of muscles in the airways and swelling of airway linings
• Production of excess mucus which clogs, and may block, the airways in the lungs
• Trapping of air in the lungs so that it becomes hard to breathe

Initially, you might just notice symptoms of wheezing, but as an attack gets worse your chest gets tighter and you become short of breath. Eventually, you may feel like you can't get enough air.

How to avoid an asthma emergency

Three people die from asthma each day in the UK. That’s more than 1,000 people a year. An estimated 90% of these deaths can be prevented if you know the warning signs and what action to take. What to do in the event of an emergency should be part of your personal asthma plan. Click on the next slide for important warning signs to watch out for.

Early warning signs

Lots of people get early signs of an imminent asthma attack days or hours before it happens. Everyone’s signs are different but they may include:

• Having to use your inhaler more often
• A lack of appetite, headache, or coughing, especially at night
• Trouble sleeping, fatigue and tight chest
• Less tolerance for exercise

See your GP or asthma nurse if you are experiencing these signs.

Persistent cough

A chronic or persistent cough that you can’t seem to shake off is a sign of uncontrolled asthma and may be a sign of an imminent asthma attack. The cough is usually dry and hacking and more common at night. It may also get worse in certain locations or during certain activities. The cough may improve with the use of inhaled or oral steroids or other asthma medicine. If you experience this symptom, don’t take cough medicine as that won’t help the asthma, but do have a medical check-up. If the cough progresses to severe shortness of breath or chest pain, seek urgent medical help.

Check your breathing

Changes in the readings on a device called a peak flow meter can be a sign of an asthma attack. Make sure you know the normal baseline measurement for you when you’re breathing well.

• If your peak flow meter registers a reading that’s between 50% to 79% of your personal or predicted best, an asthma attack has probably started.
• A reading below 50% of your personal or predicted best means you have an acute severe asthma attack that’s an emergency and needs immediate help.

If you have the above signs, don’t hesitate to call 999, especially if you have trouble walking or talking due to shortness of breath, or if your lips turn blue or grey, which is a sign you aren’t getting enough oxygen.

Have an asthma action plan

A personal action plan is critical for you to be able to deal with an emergency. Track your own personal signs of an attack, so you’ll recognise them if it happens again. Friends and family should also be aware of your symptoms, your plan details and know how to help during an attack. The charity, Asthma UK, provides free Asthma Attack Cards that explain how to recognise an asthma attack and what to do about it. Always carry a rescue inhaler and use it. Parents of children with asthma should alert carers and teachers about what to do in an emergency. Based on peak flow measures, your plan should detail exactly what medicines need to be taken, how and when, and when to seek emergency medical advice or call 999. If symptoms get worse despite executing the plan, follow the plan’s emergency instructions. Failure to treat an asthma attack can be life threatening.

Posture changes

During an asthma attack it can become more of an effort to support yourself in an upright position. The effort to breathe may make you lean forward, speak in words instead of sentences and become noticeably agitated. As the attack gets more severe, you may move into a leaning, hunched or sitting position with your hands supporting your upper body. This is known as the tripod position and is believed to help the body use the muscles of the chest and neck to get more air into the lungs.

Chest and neck retractions

If the chest and neck is drawn inwards with each breath, it’s a sign of an unconscious struggle to breathe known as retraction.

Retractions usually mean there’s not enough air getting into the lungs, which is a medical emergency. Call 999 right away.

In children, other signs of breathing problems include:

• Poor appetite
• Fatigue
• Decreased activity
• Complaints of a tummy ache.

Blue lips or fingernails

If you notice your lips or fingernails look blue or grey it’s a sign that you may not be getting enough oxygen. The condition is called cyanosis and it’s an emergency situation. Call 999 immediately.

Emergency asthma symptoms

Everyone is different, but common signs of a medical emergency include:

• Symptoms get worse despite treatment
• Wheezing, chest tightness, trouble breathing or talking
• Flaring nostrils and sucking in chest trying to breathe
• Problems walking
• Pale, sweaty face
• Blue or grey tinge on lips and fingernails
• Racing pulse and agitation or restlessness

These are symptoms you shouldn’t ignore. If you notice any of the above, call 999 and get emergency help at once.

What to do during an attack

The charity Asthma UK suggests these steps to follow during an asthma attack:

1 - Sit up straight - don't lie down. Try to keep calm.

2 - Take one puff of your reliever inhaler (usually blue) every 30-60 seconds, up to a maximum of 10 puffs.

3 - If you feel worse at any point while you're using your inhaler or you don't feel better after 10 puffs or you're worried at any time, call 999 for an ambulance.

4 - If the ambulance is taking longer than 15 minutes you can repeat step 2.

If you feel better without having to call for help, make sure you visit your GP or an asthma nurse for a check-up within 24 hours. Note – this advice is not appropriate for those on MART (maintenance and reliever therapy) or SMART regime. During an asthma attack those on a MART or a SMART regime should contact their doctor or asthma nurse for advice.

More reading on asthma:

• Slideshow: A visual guide to asthma
• Surprising sources of indoor air pollution
• Quiz: What’s your asthma IQ?
• Asthma medications