Asthma Attack  

This Care Guide Covers:

  • Your child is having an asthma attack
  • Use this guide only if a doctor has told you your child has asthma

If not, see these topics
  • Wheezing but no past diagnosis of asthma. See WHEEZING.
View First Aid Advice
  • First Aid for Anaphylaxis - Epinephrine

View images
How to Use a Dry Powder Inhaler
How to Use a Dry Powder Inhaler

How to Use a MDI
How to Use a MDI

How to Use a MDI with Spacer
How to Use a MDI with Spacer

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Wheezing and life-threatening allergic reaction to similar substance in the past
  • Starts to wheeze suddenly after taking medicine, an allergic food or bee sting
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Looks like he did when hospitalized before with asthma
  • Lips or face have turned bluish during coughing
  • Trouble breathing not gone 20 minutes after neb or inhaler
  • Peak flow rate less than 50% of normal rate (RED Zone)
  • Peak flow rate 50-80% of normal rate after using neb or inhaler (YELLOW Zone)
  • Wheezing (heard across the room) not gone 20 minutes after using neb or inhaler
  • Nonstop coughing not improved after using neb or inhaler
  • Severe chest pain
  • Need to use asthma medicine (neb or inhaler) more often than every 4 hours
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Mild wheezing lasts over 24 hours on treatment
  • Sinus pain (not just congestion)
  • Fever for more than 3 days
  • Fever returns after gone for more than 24 hours
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Don't have written asthma action plan from your doctor
  • Use an inhaler, but don't have a spacer
  • Miss more than 1 day of school per month for asthma
  • Asthma limits exercise or sports
  • Asthma attacks wake child up from sleep
  • Use more than 1 inhaler per month
  • No asthma check-up in over 1 year
Parent Care at Home If
  • Mild asthma attack
Causes & Health Information

Symptoms

  • Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
  • Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound.  You can hear it best when your child is breathing out.

Causes (Triggers) of Asthma Attacks

  • Infections that affect breathing (like colds or the flu)
  • Pollens
  • Animals (like cats)
  • Tobacco smoke
  • Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
  • Asthma attacks caused by food allergy can be life-threatening

Asthma Attack Scale

  • Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard. (GREEN Zone: Peak Flow Rate 80-100% of normal rate)
  • Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. (YELLOW Zone: Peak Flow Rate 50-80% of normal rate)
  • Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. (RED Zone: Peak Flow Rate less than 50% of normal rate)
CARE ADVICE FOR ASTHMA ATTACK

  1. What You Should Know:
    • Over 10% of children have asthma.
    • Your child's asthma can flare up at any time.
    • When you are away from your home, always take your child's medicines with you.
    • The sooner you start treatment, the faster your child will feel better.
    • Here is some care advice that should help.
  2. Asthma Quick-Relief Medicine:
    • Your child's quick-relief (rescue) medicine is albuterol or xopenex.
    • Start it at the first sign of any wheezing, shortness of breath or hard coughing.
    • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
    • Repeat it every 4 hours if your child is having any asthma symptoms.
    • Never give it more often than 4 hours without talking with your child's doctor.
    • Coughing. The best "cough med" for a child with asthma is always the asthma medicine. (Caution: don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough.)
    • Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
    • Use the medicine until your child has not wheezed or coughed for 48 hours.
    • Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
  3. Asthma Controller Medicine:
    • Your child may have been told to use a controller drug. Examples are inhaled steroids or cromolyn.
    • During asthma attacks, keep giving this medicine to your child as ordered.
  4. Hay Fever:
    • For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
  5. Fluids:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.
  6. Humidifier:
    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
  7. Avoid or Remove Allergens:
    • Shower to remove pollens or other allergens from the body and hair.
    • Avoid known causes of asthma attacks (such as smoke or cats).
    • Do not take part in sports during the attack.
  8. What to Expect:
    • If treatment is started early, most asthma attacks are quickly brought under control.
    • All wheezing should be gone by 5 days.
  9. Call Your Doctor If:
    • Trouble breathing occurs
    • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
    • Wheezing lasts over 24 hours
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.