Asthma Attack

Don’t use this guideline unless your child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician

Main Symptoms

  • The classic symptom is a wheeze or whistling (purring) sound on breathing out.

See More Appropriate Topic

  • If no previous asthma diagnosis or use of asthma medicines, see Wheezing

Call 911 Now (your child may need an ambulance) if

  • Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)
  • Your child passed out or has bluish lips/tongue
  • Wheezing started suddenly after medicine, an allergic food or bee sting

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Looks like he did when hospitalized before with asthma
  • Difficulty breathing not resolved 20 minutes after neb or inhaler
  • Peak flow rate < 50% of baseline level (personal best)
  • Peak flow rate <50-80% of baseline level after using neb or inhaler
  • Wheezing (heard across the room) not resolved 20 minutes after using neb or inhaler
  • Continuous (nonstop) coughing that keeps from playing or sleeping and not improved after using neb or inhaler
  • Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours
  • Fever > 104°F (40°C)
  • Severe chest pain

Call Your Doctor Within 24 Hours (between 9 and 4) If

  • You think your child needs to be seen
  • Lots of yellow or green nasal discharge now with a fever
  • Sinus pressure or pain
  • Fever present > 3 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Missing > 1 day of school/month for asthma
  • Asthma limits exercise or sports
  • Asthma attacks frequently awaken from sleep
  • Uses more than 1 inhaler/month
  • Mild wheezing persists > 5 days
  • No asthma check-up in > 1 year

Parent Care at Home If

  • Mild asthma attack and you don’t think your child needs to be seen

Home Care Advice for Asthma Attack

  1. Asthma Medicine:
    • Start the inhaler, nebs or oral asthma medicine at the first sign of any coughing or shortness of breath (don’t wait for wheezing).
    • The best “cough medicine” for a child with asthma is always the asthma medicine. Continue the asthma medicine until your child has not wheezed or coughed for 48 hours.
    • It takes a minimum of 7 days of medicine for lung function to return to normal.
  2. Hay Fever: For nose allergy symptoms, it’s OK to give antihistamines.
  3. Fluids: Encourage a normal intake of clear fluids (e.g. water). (Reason: normal fluid intake keeps the lung mucus from becoming sticky.)
  4. Humidifier: Humidifier: If the air is dry, use a humidifier (Reason: to prevent drying of the upper airway.)
  5. Avoid or Remove Allergens: Give a shower to remove pollens, animal dander, or other allergens from the body and hair. Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows, exercise).
  6. Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
  7. Call Your Doctor If
    • Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours
    • Wheezing is not completely cleared by 5 days
    • Your child becomes worse or develops any of the “Call Your Doctor Now” symptoms