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What Is an Asthma Exacerbation? 5 Symptoms and 3 Treatments

Medically reviewed by Dennrik Abrahan, M.D.
Written by Emily Wagner, M.S.
Posted on March 7, 2023

Asthma is a common lung disease that affects people of all ages, but it often starts during childhood. This long-term condition affects your ability to breathe properly because of inflammation and narrowed airways in your lungs.

When severe inflammation occurs and your asthma symptoms make breathing hard, you may be having an asthma exacerbation or asthma attack. An exacerbation may be caused by one of your asthma triggers over a period of time, or it may come on suddenly.

Learning to recognize the signs of an exacerbation and how it’s treated can help you prepare and avoid needing further treatment. If you’re having frequent exacerbations, your doctor may prescribe medication for you to take regularly to help prevent these attacks.

What Is an Asthma Exacerbation?

During an asthma exacerbation, you may have trouble breathing due to excess inflammation and narrowing of your airways. Your lungs also create a thick mucus that blocks airflow and limits oxygen, eventually causing symptoms.

You’re at an increased risk of an attack if you have severe or uncontrolled asthma. Attacks can be mild, severe, or even life-threatening. Knowing your asthma triggers can also help you avoid an exacerbation. Common triggers include:

  • Viral respiratory infections (such as the common cold)
  • Environmental allergens, including dust mites, pollen, and pet dander
  • Tobacco smoke
  • Chemical fumes or air pollution
  • Exercise
  • Cold air

You can work with your doctor to better understand what your triggers are so that you can try to avoid them. Everyone’s triggers are different. You may not always be able to prevent an asthma exacerbation, but you can take steps to be prepared.

Symptoms of an Asthma Exacerbation

Asthma symptoms can vary based on the season or from year to year. Remember — asthma symptoms and an asthma exacerbation are often similar, but symptoms are much worse during an exacerbation. In less severe cases, your symptoms might last just a few minutes, but they can also linger for several hours or even days.

If you’re experiencing the following symptoms more frequently or you find yourself using your quick-relief (rescue) inhaler more often, this may be a sign that your asthma is getting worse. Also, be aware that you don’t need to have each one of these symptoms — or for them to occur in the order below — for your experience to be considered an asthma exacerbation.

1. Shortness of Breath

During an asthma exacerbation, you may experience shortness of breath. This may cause you to feel as though you’re suffocating or that you can’t catch your breath. Breathing becomes difficult — you can’t take deep breaths — and it may occur during rest or physical activity. If you’re struggling to breathe, the skin on your neck and chest may begin to suck inward as you take breaths.

2. Coughing

You may have a tight, dry cough that won’t stop, making it harder for you to catch your breath. These coughs are typically nonproductive — they don’t help clear your throat or any mucus in your lungs. It’s more common for coughing to occur early in the morning or at night, waking you from a sound sleep.

3. Wheezing

Wheezing makes a purring or whistling sound and is usually audible when you breathe out. It may start like a low-pitched whistle and get higher-pitched as you breathe. You may also feel a rattling sensation in your chest.

4. Chest Tightness

You may feel a tight, squeezing pressure that feels like someone is sitting on your chest or the air is being sucked out of you. These sensations make it hard for you to catch your breath, and you may start to feel lightheaded.

5. Low Peak Expiratory Flow Readings

If you have chronic asthma, your doctor may give you a peak flow meter (PFM) to measure the amount of air you breathe out. During an asthma attack, your airways narrow and block airflow, dropping your peak expiratory flow (PEF) readings. A reading between 50 percent and 80 percent lets you know it’s time to use your rescue medication. If your PEF reading falls below 50 percent, you should immediately seek emergency care.

Treatments for an Asthma Exacerbation

Your doctor may prescribe one or more medications to treat different factors contributing to your asthma attacks. Some medications help reduce swelling, while others open the airways so you can breathe better.

These medicines are typically administered with an inhaler, sometimes paired with a spacer. Your inhaler may have more than one medication to help manage your symptoms. Your doctor may recommend carrying these quick-relief medications with you at all times in case of a sudden asthma attack. Some people have difficulty using an inhaler, so be sure to let your health care provider know if you have trouble with the technique.

The type of treatment needed depends on how severe the exacerbation is. If the asthma attack is mild, a quick-relief inhaler may relieve your symptoms. However, if your symptoms continue or worsen even after using a quick-relief inhaler, your doctor may recommend going to the emergency room to receive additional medications and medical care.

One key component of managing asthma attacks is working with your doctor to create an asthma action plan. This plan — written document created with your doctor specifically for you — contains the following details:

  • How to identify triggers
  • How to know when an asthma attack is happening
  • Which medicines to take and when
  • When to get emergency treatment for an asthma attack
  • Who to contact when you’re having a severe asthma attack

Here’s a list of medications you may have in your rescue inhaler or that you might receive in the emergency room to help treat an asthma exacerbation.

1. Short-Acting Beta-2 Agonists

Short-acting beta-2 agonists (SABAs) help open the airways in your lungs so that air can flow more easily, making it easier to breathe. These medications are typically prescribed as rescue inhalers or for use in a nebulizer, which creates a medicated mist to inhale.

The two most commonly used SABAs for an asthma attack are albuterol sulfate (sold as ProAir, ProAir Respiclick, Proventil HFA, and Ventolin HFA) and levalbuterol tartrate (Xopenex HFA).

2. Corticosteroids

Corticosteroids are also known as steroids. This type of medication may be given in the emergency room to reduce airway inflammation during an asthma attack. Corticosteroids can be given as tablets to be taken orally (by mouth). In severe cases, they may also be given in the emergency room as an intravenous injection to alleviate an attack.

Prednisone is an example of an oral corticosteroid used to treat asthma exacerbations. Oral corticosteroids are typically used only for short-term treatment because they may cause unwanted side effects, including osteoporosis (bone thinning) and weight gain.

Inhaled corticosteroids are typically used as maintenance therapies to prevent asthma exacerbations. However, recent studies have found that combining an inhaled corticosteroid, such as budesonide, with albuterol in a rescue inhaler can help treat asthma attacks and improve lung function.

3. Short-Acting Muscarinic Antagonists

Short-acting muscarinic antagonists (SAMAs) are occasionally used to treat asthma attacks when albuterol isn’t completely effective. Like SABAs, SAMAs also open up airways to help you breathe easier. The most commonly used SAMA is ipratropium bromide (Atrovent).

When To Seek Emergency Treatment

Because asthma attacks can be life-threatening, it’s important to recognize when to seek immediate help. Signs that you may need emergency treatment for an asthma attack include:

  • Lack of symptom improvement, even after using quick-relief medication
  • Extreme wheezing or shortness of breath, even during rest
  • Signs of low oxygen levels, such as fingernails or lips turning blue or gray
  • Trouble concentrating
  • Confusion or agitation

If you or a loved one is experiencing any of these symptoms, an emergency department can provide additional support. Follow your asthma action plan to determine when to seek emergency care. If someone can’t drive you to the nearest emergency department, call 911. Paramedics can administer immediate treatment and continue to assess your symptoms on the way to the hospital.

When To Check In With Your Doctor

If your current medications don’t control your symptoms, follow up with your primary care doctor to discuss the next steps for your asthma medications. Your doctor may decide to check your lung function through a series of tests, including spirometry. This common test to determine your lung function and asthma severity can be done in your doctor’s office.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Have you experienced asthma exacerbations? What treatments have worked for you? Share your thoughts or tips in the comments below or by posting on your Activities page.

    Posted on March 7, 2023
    All updates must be accompanied by text or a picture.

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    Dennrik Abrahan, M.D. received his medical degree from the University of Central Florida. Learn more about him here
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here

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