Asthma emergency or asthma first aid

To manage an acute asthma episode, follow the A-S-T-H-M-A steps: Assess, Sit, Treat, Help, Monitor, All Okay (explained below). If the person has severe asthma or is frightened, call an ambulance on 111, and say it is an acute asthma episode.

What is an acute asthma episode?

People with asthma have extra-sensitive airways. In an acute asthma episode, people's airways may swell and narrow, causing wheezing, coughing and difficulty breathing. It is important to recognise and treat an asthma episode as soon as possible, so it can be brought back under control.

What to do if someone has an acute asthma episode?

Follow the A-S-T-H-M-A steps to help someone having an acute episode or needing asthma help: Assess, Sit, Treat, Help, Monitor, All Okay - details below.

A: Assess the severity of asthma attack

• Mild symptoms might include:
  Short of breath, wheeze, cough, chest tightness.
• Moderate symptoms might include:
  Loud wheeze, breathing difficulties, can only speak in short sentences.
• Severe symptoms might include:
  Distressed, gasping for breath, difficulty speaking two words, blueness around the mouth.

If the person has severe asthma or is frightened, call an ambulance immediately on 111.

S: Sit

Be calm and reassuring. Sit the person down and get them to lean forward slightly. Ensure that their arms are supported by their knees, a table or the arms of a chair.

T: Treat

Give 6 puffs (1 puff at a time) of a blue 'reliever' inhaler (eg, Ventolin, Salamol, Respigen or Bricanyl). Use the person’s own inhaler if possible. If not, use a First Aid kit inhaler or borrow one from someone else. Remember to give just 1 puff at a time - the person takes 6 breaths for each puff.

Relievers are best given through a spacer (except for Bricanyl which cannot be used with a spacer). A spacer makes the delivery of the drug more effective. If no spacer is available you can use a polystyrene cup: punch a hole in the bottom and insert the inhaler through the hole. Place the top end of the cup over the patient's mouth and nose and activate the inhaler.

Treatment given with spacer:

• Shake inhaler and insert mouthpiece into spacer
• Place spacer mouthpiece in person’s mouth and fire one puff
• Ask the person to breathe in and out normally for about 6 breaths 
• Repeat in quick succession until 6 puffs have been given.

Treatment given without spacer:

• Shake inhaler
• Place mouthpiece in the person’s mouth
• Fire 1 puff as the person inhales slowly and steadily
• Ask the person to hold that breath for 6 seconds, then take 6 normal breaths. Repeat until 6 puffs have been given.
  

H: Help

If not improving after 6 minutes, CALL AN AMBULANCE (DIAL 111) and state simply and clearly that the person is having an acute asthma episode. Continue to use the blue (reliever) inhaler as above to give 6 puffs every 6 minutes until help arrives. In an emergency situation you will not overdose the person by giving them the reliever every 6 minutes.

M: Monitor

If improving after 6 minutes, keep monitoring. If necessary, repeat doses of the reliever inhaler.

A: All OK

The person with asthma can return to normal quiet activities when they are free from wheeze, cough and breathlessness. If symptoms recur, repeat treatment and rest. See your doctor.

What if it’s someone’s first acute asthma episode?

If someone collapses and appears to have difficulty breathing, CALL AN AMBULANCE IMMEDIATELY, whether or not the person is known to have asthma.

• Give 6 puffs of a reliever and repeat if no improvement.
• Keep giving 6 puffs every 6 minutes until the ambulance arrives.
• No harm is likely to result from giving a reliever to someone who does not have asthma.
  

Related topics

Also see: Asthma medicines and Puffers and other devices and Asthma triggers

Original material provided by The Asthma Foundation of New Zealand. Reviewed by everybody, October 2010.