• If you have or care for a child with asthma, it’s essential to work with a pediatrician to develop an action plan for an asthma emergency.
• The first, most important step is to recognize the warning signs of an asthma attack.
• An action plan should note the danger signs of an asthma attack that requires emergency attention.

An asthma emergency, also known as an asthma attack or severe asthma flare-up, can be a frightening experience for children and their caregivers. During an asthma attack, lung function is impaired, and it becomes hard to breathe because muscles around your child’s airways contract, narrowing their airways. Excess mucus or other triggers can make breathing even more difficult.

If you have a child with asthma or care for a child with the condition, it’s essential to work with a pediatrician to prepare a personalized asthma action plan — an asthma treatment plan for an asthma emergency. An effective action plan is a document that includes information about your child’s asthma medicines and how to use them, what signs and symptoms to look for, and whom to contact if emergency care is needed.

You should make sure that you, age-appropriate family members, and any other caregivers are familiar with the plan and have easy access to copies of it. The same goes for teachers, nurses, and others who care for a child with asthma outside of the home.

An integral part of an asthma action plan is being certain that your child’s rescue medications and chambers are accessible wherever your child might be, such as at home, school, or anywhere else they frequent. Be sure the medications haven’t expired and there are enough in case an attack occurs. Storing a printed copy of the treatment plan with the medications is also important.

Identify the Signs of an Asthma Emergency

The most important step to take during an asthma emergency is recognizing when one is happening. An asthma attack can look different for everyone. The most common warning signs and symptoms include:

• Severe shortness of breath or trouble breathing
• Chest tightness or chest pain
• Coughing and wheezing
• Rapid, shallow breathing
• Lightheadedness or dizziness
• Inability to speak in full sentences
• Feeling anxious or scared
• Peak flow readings less than 80 percent of your best score
• Little to no improvement after using quick-relief medicine, or needing medication again within a couple of hours

Spotting signs of an asthma emergency in young children may be difficult, especially if they can’t tell you what’s wrong. Young children may exhibit the following behaviors during an asthma emergency:

• Restlessness or difficulty sleeping
• Trouble eating and drinking
• Coughing
• Vomiting
• Head bobbing
• Skin between their ribs and around the collarbone pulling with each breath
• Belly breathing (using their stomach to pull in a breath)
• Nostrils opening wider than usual with each inhale
• Breathing that’s faster than normal for longer than a few seconds
• Crying more softly than normal
• Difficulty sucking on a bottle or pacifier

Keeping Your Child Upright and Calm

Once you recognize the signs and symptoms of an asthma attack, you should get your child into a safe, comfortable position to make breathing easier. If possible, help them sit upright, rather than staying hunched over or lying down. Propping them up with pillows may help. Loosen any tight clothing around their neck, chest, or waist that may make breathing more difficult.

Don’t leave your child alone during an asthma attack. Stay with them and watch for worsening symptoms, and refer to your asthma action plan as soon as possible.

Try to keep your child as calm as possible. This may be difficult — asthma attacks can be scary — but anxiety can increase a person’s breathing and heart rate, worsening their asthma symptoms. If the attack happens outdoors, you may want to bring your child inside where there’s air conditioning or heat, depending on the time of year.

Prepare an Asthma Action Plan

Make sure to fill out your child’s asthma action plan with a doctor before an emergency occurs. The plan will include important emergency numbers for health care professionals, medication doses, and next steps. An asthma action plan template is available from the Centers for Disease Control and Prevention (CDC).

Having a plan prepared in advance is very important, as you may feel too flustered or anxious during an asthma emergency to remember what to do. A MyAsthmaTeam member shared, “I am so glad I filled in my asthma action plan. It helped to remind me what to do when I was having another asthma attack.”

Importantly, make sure your child’s plan and medications are easy to access during an emergency — both for yourself and your child’s caregivers.

An asthma action plan should specify exactly which medication to use, how much, and how often, based on the symptoms your child is experiencing. Make sure to clarify this information with your child’s doctor when filling out your plan.

Using an Asthma Action Plan

The American Family Physician guidelines on managing acute asthma exacerbations suggest using a bronchodilator, such as albuterol, at the first sign of an asthma attack. Your child can use a metered dose inhaler or a nebulizer, depending on your doctor’s advice. If you use a metered dose inhaler, a spacer device helps your child get more medication into their lungs.

Be sure to follow the precise instructions on the asthma action plan. Check that you’re using the correct inhaler, which can be confusing during an asthma attack. Your asthma action plan will tell you how many puffs of quick-relief, or rescue, medication your child should take — usually between two and six. You can repeat this step after 20 minutes. If your child doesn’t feel better after two treatments of quick-relief medication, you should call your child’s doctor immediately.

If your child’s doctor has recommended a combination inhaler, newer guidelines may have your child use the same inhaler for prevention and treatment of asthma emergencies. Your child’s doctor can tell you if this is right for your child, and this information should be included in their asthma action plan.

Recognize Danger Signs and the Need for Medical Attention

Your asthma action plan should note the danger signs of a life-threatening asthma emergency that requires calling an ambulance or taking your child to the nearest emergency department. Make sure you and your child’s caregivers can recognize severe asthma symptoms and watch closely for them.

Based on symptoms or peak flow meter readings, the action plan can also help you determine if the asthma attack is in the yellow zone (you should call your child’s doctor) or the red zone (a medical emergency).

Other examples of danger signs include:

• Severe breathlessness
• Trouble walking due to shortness of breath
• Lips, gums, or fingernails turning blue, purple, or gray
• Drowsiness

Don’t be afraid to call for help during an asthma emergency. If you notice any danger signs during an asthma emergency, take your child to the emergency department of the nearest hospital or call 911 right away.

Taking Steps After an Asthma Emergency

After an asthma attack, you should call your child’s pediatrician as soon as you can — within one or two days, at most — to discuss what happened and how to prevent future attacks. You may need to change your child’s asthma action plan or make medication adjustments.

Your child may not feel like themselves after a severe asthma attack. A doctor may be able to recommend ways to help with the recovery process. One member said, “I had an asthma attack this morning. Feeling better now, just very tired.”

Prevent Asthma Emergencies

Your child’s doctor may recommend a prevention plan that might include changes to their asthma control medicines, reliever medications, avoidance of triggers, and strategies to improve asthma management.

It’s important to know what sets off your child’s asthma symptoms so you can take steps to make sure they avoid those triggers. Your child’s asthma triggers may be different from someone else’s. Common triggers include allergic reactions and irritants such as:

• Allergens like pet dander and pollen
• Dust mites
• Cockroaches
• Mold
• Air pollution
• Respiratory infection
• Tobacco smoke or vaping
• Cleaning supplies like bleach
• Exercise
• High humidity
• Rapid weather changes

MyAsthmaTeam members have shared some of their triggers. One member said, “I have had two asthma attacks today. Bleach sets off my asthma badly. Where I am staying, they use bleach to clean.”

Another member shared their strategy for avoiding high pollen counts, one of their triggers: “I decided to look up the allergy forecast for my city, and it said the risk of asthma is high. I will only do what I need to do, then return to my air conditioning.”

Talk to your child’s doctor about how to best prevent, prepare for, and respond to an asthma emergency. You should make sure you always have enough quick-relief medication and that it’s easily accessible.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 11,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Have you or your child experienced an asthma emergency? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.