Asthma is caused by underlying inflammation of the bronchial tubes (airways). This can lead to constriction that may make it feel harder to breathe.

If the inflammation and constriction are severe and you feel that you’re struggling or breathing rapidly, you may be experiencing an asthma attack.

But identifying an asthma attack isn’t always clear-cut. Learn what the symptoms are for difference stages of a possible asthma attack, how you can treat them, and when you should seek medical help.

An asthma attack is caused by the quick onset of severe airway inflammation and constriction. This is often a response to triggers like allergens, smoke, and weather changes.

An asthma attack is known for causing breathing difficulties, but the exact symptoms can also depend on whether the episode is more mild or moderate. It’s also important to know which symptoms are indicative of a medical emergency.

Mild symptoms

During a mild asthma attack, you’ll likely experience classic signs like:

  • wheezing
  • shortness of breath
  • chest tightness

In a mild asthma attack, these symptoms may resolve by avoiding a known asthma trigger and with a quick-relief (rescue) inhaler within minutes.

Moderate symptoms

The differences between mild and moderate asthma attack symptoms may not be as clear-cut.

As a rule of thumb, more symptoms may be considered more moderate if you’re having more severe breathing difficulties.

And unlike mild asthma attack symptoms, signs of a more significant asthma attack can last for several hours. You may need to take a rescue inhaler more than once.

Severe (emergency) symptoms

You may need emergency medical treatment if your asthma symptoms don’t improve despite using a quick-relief inhaler.

Severe (acute) asthma attack symptoms may include:

  • worsening cough
  • rapid breathing
  • shortness of breath
  • heart rate changes
  • chest tightness that spreads to your neck
  • pale or purple-tinted skin
  • an inability to talk or eat
  • confusion

Early signs of a mild to moderate asthma attack ought to be treated at home with a rescue inhaler. You can also sit up and take slow breaths to help encourage steady breathing.

See a doctor if you’re finding that you need your inhaler several times per day for more than a few days. They’ll take a look at your asthma treatment plan and see whether any modifications need to be made, such as prescribing different long-term controller medications.

Go an urgent care center or emergency department if your symptoms are severe or if you’re having difficulty breathing.

Traditional long-term controller medications, such as inhaled corticosteroids, are designed to help prevent the onset of an asthma attack. That’s why it’s important to take these as prescribed.

But it’s still possible to have an asthma attack, especially if you have more severe asthma or if you’re exposed to one of your triggers.

For all people with severe symptoms of asthma, use a rescue inhaler (sometimes called an inhaled short-acting bronchodilator) quickly, such as albuterol.

If your response to rescue inhaler therapy isn’t enough to treat your symptoms, continue to follow your asthma action plan or talk with a doctor for specific instructions.

At this point, you’ll likely be given oral glucocorticoids. Be sure to discuss the possible side effects of oral glucocorticoids with a doctor before taking them. They include:

  • sleep disturbance
  • increased appetite
  • gastric irritation
  • mood changes

Preventing asthma attacks depends on a combination of following your asthma treatment plan while also avoiding your triggers as much as possible.

If you have severe asthma that is not optimally controlled, you are at a higher risk of experiencing frequent asthma attacks.

Individual asthma triggers can vary, but may include:

  • allergies, such as seasonal pollen, animal dander, and dust mites
  • sensitivities to certain foods or preservatives
  • air pollution and fire smoke
  • chemical irritants, such as fumes or perfumes
  • cigarette smoke
  • strenuous exercise
  • certain medications, such as beta-blockers or nonsteroidal anti-inflammatory drugs (NSAIDs)
  • upper respiratory infections
  • certain weather changes, particularly cool, dry air
  • stress, anxiety, or other emotional changes that may alter your breathing patterns
  • certain workplaces, with manufacturing jobs reporting high rates of asthma attacks

While it’s not always possible to avoid asthma triggers, try these tips to manage your asthma:

  • Try antihistamines (ones that don’t cause drowsiness) during allergy season or when you’re exposed to other allergens.
  • Stay indoors during days when the air quality is poor. You can find the air quality index in your area here.
  • Clean your home regularly, including weekly vacuuming and dusting. Consider purchasing an air purifier.
  • Avoid exposure to cigarette smoke and other fumes whenever possible.
  • Wear a scarf or mask around your face if you must go outside during extremely cold days.
  • Take your rescue inhaler several minutes before vigorous activities, particularly if you have a history of exercise-induced bronchoconstriction.
  • Be up to date with respiratory vaccines. This includes vaccines for pneumococcal viruses, COVID-19, and the seasonal flu. Wash your hands regularly and consider wearing a mask along with social distancing when in close contact with others who are sick — especially during cold and flu season.
  • Always carry a rescue inhaler with you at work, school, or when traveling.
  • Have an Asthma Action Plan. This is a written, individualized worksheet that shows you the steps you can take to keep your asthma from getting worse. It also provides guidance on when to call a healthcare provider or go to the emergency department.

The best strategy for managing acute, severe asthma symptoms is recognizing and intervening before attacks become severe and potentially life-threatening.

A rescue inhaler and removal of the asthma trigger may help treat an occasional mild asthma attack without further need for medical attention. But seek immediate emergency help if you have severe symptoms like trouble breathing and being unable to speak more than short phrases.

If you have frequent asthma attacks and rely on quick-relief medications on a regular basis, see a doctor for further evaluation and treatment.