Asthma isn’t one-size-fits-all. There are different levels of severity, and it’s important to know the signs. That way, you’ll know what to do if it happens to you.

A severe asthma attack is a potentially life threatening event. Symptoms of a severe attack might be similar to the symptoms of a minor asthma attack, especially at first.

The difference is that severe attacks don’t improve with home treatment. These events need emergency medical treatment to prevent death. If you suspect you or a loved one is having a severe asthma attack, go to an emergency room right away.

By contrast, a mild asthma attack may only last a few minutes and will respond to rescue medication.

A moderate asthma attack will last longer and may not respond to rescue medication right away.

If quick-relief medication fails to work after 10 to 15 minutes, go to the emergency room.

A severe asthma attack starts a lot like a minor asthma attack.

Early signs of asthma attacks include:

  • severe coughing
  • wheezing
  • shortness of breath
  • chest tightness
  • fatigue
  • itchiness
  • nervousness
  • irritability

Symptoms of a severe asthma attack may include:

  • discolored lips, face, or nails that might be blue or gray
  • extreme difficulty breathing
  • difficulty talking or walking
  • mental confusion
  • extreme anxiety caused by breathing difficulty
  • chest pain
  • rapid pulse
  • chest retractions
  • drowsiness

You might feel mucus buildup and some chest pain due to your bronchial tubes narrowing. You’ll likely wheeze and cough. Breathing is a challenge, especially during activities like walking. It can be difficult to talk as well.

Given that these symptoms are like a minor asthma attack, what makes a severe asthma attack different?

The key is treatment response.

You’ll know your asthma attack is severe if your symptoms don’t improve with your routine treatment measures, such as your rescue (“quick-acting”) inhaler.

In addition to an inhaler, a peak flow meter can show you how open the airways are in your lungs with a reading called peak expiratory flow (PEF). Lower readings from a peak flow meter can show the severity of an asthma attack.

Although no single parameter defines a severe asthma attack, lung function is a useful method of assessment. According to a 2011 study, a PEF of 40 percent or less of typical function indicates a severe attack in people 5 years and older.

This scale uses four designations that include:

  • Mild is a PEF greater than 70 percent that can be treated at home.
  • Moderate is a PEF of 40 to 69 percent that usually requires an office or emergency room visit.
  • Severe is a PEF lower than 40 percent that usually requires a visit to the emergency room and hospitalization.
  • Life threatening is a PEF under 25 percent that usually requires hospitalization and possibly intensive care.

On the other hand, Johns Hopkins Medicine uses colors to indicate three peak flow zones: green, yellow, and red.

  • Green means “go,” and is 80 to 100 percent of your highest peak flow reading, or personal best.
  • Yellow means “caution,” and involves 50 to 80 percent of your personal best.
  • Red refers to anything below 50 percent. This means “stop.” Get help right away.

According to Johns Hopkins Medicine, a PEF reading below 50 percent of full lung function indicates a medical emergency. If you receive this reading, get help right away.

Your asthma treatment depends on how severe your symptoms are on a regular basis. If you have severe asthma, it’s likely that you already take long-term control medications. You may also have a rescue inhaler on hand just in case an asthma attack occurs.

Severe asthma attacks don’t respond to regular asthma treatment, so you need emergency medical treatment if your rescue medications aren’t working. At the emergency room, your medical team may:

  • use a test called pulse oximetry to tell how much oxygen is in your blood
  • measure your PEF to determine how much and how fast you exhale
  • take a nitric oxide measurement to determine bronchial tube inflammation
  • measure your forced expiratory volume with a spirometry test
  • perform a chest X-ray

Once your doctor confirms that you’re having a severe asthma attack, they may administer one or more of the following:

  • albuterol, an inhaled aerosol or powder
  • ipratropium (Atrovent), a type of inhaled bronchodilator used when rescue inhalers alone are not enough
  • oral or intravenous corticosteroids to control inflammation
  • oxygen
  • a single dose of intravenous magnesium sulfate
  • intubation machines to help you breathe

After an asthma attack, there are things you can do to help your body recover as well as lower the likelihood of another attack. These include:

  • getting lots of rest
  • cleaning your sleep space
  • adjusting medications
  • practicing breathing techniques
  • eating anti-inflammatory foods

First, it’s important to get lots of rest post-attack. Your body needs to recover from the stress of an asthma attack, and you may also feel emotionally drained. Take time off work if needed and put chores on the back burner while you recover. Ask for help from friends and family for anything that can’t wait.

To ensure you’re getting the most from your rest time, clean your sleep space often to get rid of potential allergens that may aggravate asthma. This is a good practice even when not recovering from an attack. If your asthma medications are keeping you awake at night, ask your doctor if you can use them earlier in the day.

You may also want to take a look at your medication lineup in general. Was the attack a one-off, or has it become a pattern? If so, talk with your doctor about potentially adjusting your medications to better support you.

If you rely on your rescue inhaler two or more times per week, this is a sign that you and your doctor need to look at more long-term forms of asthma treatment.

You can also practice breathing techniques in conjunction with medications to help you breathe easier. Check in with your doctor about which practices are appropriate for you.

An anti-inflammatory diet may help reduce asthma symptoms, according to a 2016 study. Focus on foods that are high in:

  • omega-3 fatty acids, like fish, berries, nuts, and seeds
  • vitamin A, like liver, fish, eggs, cheese, squash, sweet potato, and dark leafy greens
  • vitamin E, like seeds, nut oils, and fruits, including avocado, mango, and kiwis

Treatment and recovery are important after a severe asthma attack, as these are both life-saving measures. But the best way to avoid severe asthma attacks is to prevent them from happening altogether. Learning your asthma attack triggers is key to prevention.

Not everyone’s asthma symptoms are alike, and everyone has different asthma triggers. It’s important to learn yours, so you can know what to avoid. Triggers that may exacerbate asthma-related inflammation include:

  • animal dander
  • chemicals, such as cleaners
  • cold temperatures
  • dry air
  • dust mites
  • heartburn
  • mold
  • perfumes and other fragrances
  • pollen
  • respiratory infections
  • smoke (from tobacco, wood, chemicals, etc.)
  • stress

It’s not realistic to assume that you’ll never come into contact with an asthma trigger. The key is to do your best to avoid any known triggers if possible.

Certain risk factors may also increase your chance of having a severe asthma attack. These include:

  • lung disease
  • cardiovascular disease
  • having a history of severe asthma attacks

If you have a suspected trigger that hasn’t yet been formally identified, talk with your doctor about testing.

Have your rescue inhaler with you at all times and consider using an inhaler spacer. A 2018 research review found that having a spacer can make your inhaler as effective as some emergency room treatments.

It’s important to remember that there’s no cure for asthma. Severe asthma attacks are a significant health risk, as these events can quickly turn fatal. What’s more, asthma attacks can interrupt your daily schedule, taking time away from family, work, and leisure activities.

The good news is that many treatments are available to help you control and prevent severe asthma attacks. Managing your asthma means not only a better quality of life but also an improved outlook for your lung health.