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What happens during an acute exacerbation of asthma?

Asthma is a chronic lung disease. It causes inflammation and narrowing of your airways. This can affect your airflow.

The symptoms of asthma come and go. When symptoms flare up and get progressively worse, it can be called:

  • an exacerbation
  • an attack
  • an episode
  • a flare-up

Your airways become swollen during an acute exacerbation. Your muscles contract and your bronchial tubes narrow. Breathing normally becomes more and more difficult.

Even if you’ve had exacerbations before and know what to do, it’s still a good idea to contact your doctor. An acute exacerbation of asthma is serious and can even become life-threatening. That’s why it’s important to recognize the symptoms early and to take appropriate action.

It’s important to develop an “asthma plan” for how to treat your symptoms. Work with your doctor to come up with a method for what to do when your symptoms flare up.

The symptoms of asthma vary. You may not have any symptoms between exacerbations. The symptoms can range from mild to severe. They may include:

An exacerbation can pass quickly with or without medication. It can also last for many hours. The longer it goes on, the more likely it is to affect your ability to breathe. The signs and symptoms of an acute exacerbation or attack of asthma include:

These signs and symptoms should be considered a medical emergency. Call your doctor immediately if any of them occur.

Acute exacerbations can be triggered by a variety of things. Some of the more common triggers are:

It may be a combination of factors that set off the chain reaction. Since there are so many potential triggers, it’s not always possible to identify the exact cause.

Learn more about what causes asthma.

Anyone who has asthma is at risk of having an acute exacerbation. That risk is greater if you’ve had one before, especially if it was serious enough for an emergency room visit. Other risk factors include:

  • using more than two rescue inhalers per month
  • having asthma exacerbations, or attacks, that come on suddenly
  • having other chronic health problems
  • smoking
  • not using asthma medication as directed
  • having a cold, flu, or another respiratory infection

One study showed that women tend to have more asthma exacerbations than men. Also, African-American and Hispanic people with asthma are admitted to the hospital for exacerbations at a higher rate than Caucasians.

If you’ve had an acute exacerbation before, you’ll probably recognize the symptoms. Your doctor will be able to make a quick diagnosis.

If it’s your first acute exacerbation, your doctor will need to know your medical history, particularly your history of asthma. To make a proper diagnosis, your doctor will likely perform a physical exam and a test of your lung function.

There are several tests that may be used to see how well your lungs are working:

Peak flow test

A peak flow test measures how fast you can exhale. To get a reading, you blow into a mouthpiece as hard as you can. You can also use a peak flow meter at home.


Your doctor may also use a spirometer. This machine can measure how fast you’re able to breathe in and out. It also determines how much air your lungs can hold. To get these measurements, you have to breathe into a special hose that’s connected to a meter.

Nitric oxide test

This test involves breathing into a mouthpiece that measures the amount of nitric oxide in your breath. A high level means your bronchial tubes are inflamed.

Blood oxygen level tests

During a severe asthma attack, it may be necessary to check the level of oxygen in your blood. This can be done using a pulse oximeter. A pulse oximeter is a small device that’s placed on the end of your finger. The test takes a few seconds to complete and can even be performed at home.

Shop for a pulse oximeter to use at home.

Most of the time, asthma exacerbations can be managed at home or with a visit to your doctor. The asthma plan you developed with your doctor can help you manage your symptoms and acute attacks.

However, acute exacerbations often result in a trip to the emergency room. Emergency treatment may include:

An acute exacerbation requires close monitoring. Your doctor may repeat diagnostic tests several times. You won’t be discharged until your lungs are functioning adequately. If your breathing continues to be labored, you may have to be admitted for a few days until you recover.

You may need to take corticosteroids for several days following the exacerbation. Your doctor may also recommend follow-up care.

Most people with asthma are able to manage symptoms and maintain a good quality of life.

An acute exacerbation of asthma can be a life-threatening event. However, you should be able to resume your normal activities once it’s under control. Of course, you’ll want to avoid known triggers and follow your doctor’s advice for management of your asthma.

If you have asthma, you should have an action plan in place. Work with your doctor to come up with a plan so you’ll know what to do when symptoms flare up.

Prevention tips

  • Make sure you have an adequate supply of your medications and follow instructions carefully.
  • Consider getting a peak flow meter for home use.
  • Tell your doctor if your medications aren’t working. The dosage can be adjusted or you can try another medication. The goal is to keep inflammation to a minimum.
  • Remember that treating an asthma attack without delay is essential. Any delays could be life-threatening.
  • Pay attention to symptoms if you have a cold or flu.
  • Get medical help right away if you think you’re having an acute exacerbation.
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It’s not easy, but if you can identify triggers for your exacerbations, you can try to avoid them in the future.

It’s important to learn how to manage your asthma. By keeping it under control as much as possible, you’ll lower the chances of having an acute exacerbation.