Managing Asthma Flare-Ups

During an asthma flare-up, sometimes called an asthma episode or an asthma attack, symptoms like coughing, wheezing, shortness of breath, and chest tightness get worse. People with asthma might go several days or longer without noticing any symptoms and then experience a sudden flare-up.

Flare-ups can range from mild to severe and can be an emergency. A good asthma treatment plan will minimize flare-ups and enable you to stop them when they occur.

Learn more about asthma flare-ups, including signs, symptoms, causes, and treatment.

What Is an Asthma Flare-Up?

During an asthma flare-up, asthma symptoms get worse. You may have only one or two symptoms, or you might have several. Circadian rhythms (your body's internal "clock") can also alter hormone secretion, which is why some healthcare experts theorize that asthma gets worse at night in some people.

Another sign that you’re experiencing an asthma flare-up is that your inhaler isn’t working as well as it usually does. You might notice that you need to take more quick-relief asthma medication than usual. 

Peak expiratory flow (PEF) is the best way to assess the seriousness of asthma flare-up. With a peak flow meter, you can measure how well your lungs are functioning and monitor your asthma symptoms. In order for a peak flow meter to be useful during an asthma flare, you need to know what your recommended normal range is. Talk with your healthcare provider about how to determine this.

Mild Flare-Up

During a mild asthma flare-up, you might experience coughing, wheezing, or mild breathing difficulties. You should be able to walk around normally and speak in full sentences.

Moderate Flare-Up

During a moderate asthma flare-up, you’ll have symptoms like shortness of breath and wheezing while you talk, exhale, or lie down. You might feel like you’re straining your neck in order to breathe deeply. Your PEF reading could be between 50% and 80% of your personal best.

Severe Flare-Up

During a severe asthma flare-up, your PEF reading might be less than 50% of your personal best. Breathing will be labored, and it might be difficult to talk, walk, or even move around much. You might feel confused, anxious, disoriented, or drowsy.

Symptoms

When your asthma symptoms flare up, certain signs and symptoms are worth keeping an eye on:

Warning Signs

Early warning signs of an asthma flare-up may include:

• Coughing
• Rapid breathing
• Shortness of breath
• Tightness in the chest
• Wheezing (a high-pitched squeaking or whistling sound when breathing)

You might also notice that you must use your asthma medications more frequently to achieve the same effect.

Severe Symptoms

In some cases, asthma can become a medical emergency. If left untreated, an asthma flare-up can lead to respiratory failure and even death. The symptoms of a severe asthma flare-up include:

• Chest retractions
• Confusion, disorientation, agitation, panic, and/or drowsiness
• Cyanosis (when the lips, face, or nails develop a blue, gray, or white tint)
• Difficulty sleeping due to breathing problems
• Difficulty talking or walking
• Extreme chest tightness
• Extremely rapid breathing
• Feeling little relief from your rescue inhaler
• Inability to exercise
• Persistently expanded chest
• Rapid nostril movements
• Uncontrollable coughing

Call 911 right away if you have any of these severe asthma symptoms.

Asthma Flare-Up Causes

There are many reasons your asthma symptoms might flare up at certain times. Some of the most common asthma triggers include:

• Allergens, such as pollen, dust, mold, pests, or pet dander
• Cold air and extreme weather conditions
• Exercise
• Gastroesophageal reflux disease (GERD), a chronic condition in which stomach acid moves into the esophagus and produces symptoms such as heartburn
• Irritants, such as smoke or fumes
• Respiratory infections
• Stress
• Strong emotions, which can alter breathing patterns
• Strong odors
• Viral infections, such as the flu

In addition to the above, some of the most common asthma triggers among children include:

• Common cold
• Crying and laughing
• Playing or running hard 
  

How to Treat an Asthma Flare-Up

To treat (and prevent) asthma flare-ups, start by creating a plan with the help of your healthcare provider. An asthma action plan is a step-by-step guide to monitoring your asthma symptoms, as well as preventing, managing, and treating your asthma flare-ups. Include details about your medical history, allergies, medications, and emergency contacts so you can get help right away if needed. 

If your child has asthma, you can distribute the asthma action plan to their teachers, school administrators, family, friends, and healthcare providers.

In addition to creating an asthma action plan, here are some of the steps you can take to treat an asthma flare-up:

Take quick-relief medications: Many people with asthma take quick-relief medications, usually through an inhaler, to open and relax the muscles in their airways right away. These “bronchodilators” are usually short-acting beta-agonists, such as albuterol.

Increasingly, combination inhalers that include the quick-acting, long-acting bronchodilator named formoterol (e.g. Symbicort a combination of budesonide and formoterol) are also being prescribed as daily controller medications and for treatment of asthma flares. If you have any questions about which inhaler you should use during a flare, talk with your healthcare provider. 

Take controller medications: People with ongoing asthma symptoms may take controller medications—usually inhaled steroids—to reduce lung inflammation. You might also need to take them on a regular basis to prevent asthma attacks. Your healthcare provider might prescribe oral steroids on a temporary basis to treat a persistent asthma flare-up.

See a specialist: If your asthma symptoms persist, your healthcare provider can refer you to a specialist (such as an allergist) to identify and treat the root cause.

When to Seek Emergency Care

A severe asthma flare-up needs to be treated before it becomes a medical emergency. Here are some of the signs that you need to seek emergency care for your asthma symptoms right away:

• Your usual medications, such as a rescue inhaler, aren’t working to relieve your symptoms.
• Your PEF readings are very low, especially after you’ve used quick-relief asthma medication.
• It’s difficult to walk, talk, sleep, exercise, and/or think clearly because of your breathing difficulties.
• Your chest tightness or pain becomes severe.
• You develop signs of cyanosis, a condition caused by a lack of oxygen in the blood. Cyanosis may cause discoloration and color changes in the skin around the eyes, mouth, fingernails, and fingertips. Your skin might turn blue, gray, purple, or white, depending on your complexion.
  

How to Prevent an Asthma Flare-Up

You can do your best to prevent an asthma flare-up before it begins. Since many asthma symptoms are caused by asthma triggers, you should:

• Monitor your symptoms to figure out what your asthma triggers are (if you don’t already know). Record your PEF readings on a regular basis and keep a log of your symptoms.
• Avoid exposure to allergens, irritants, and pollutants. For example, control pet dander at home if you have pets. If you have seasonal allergies, consider wearing a mask and closing your doors and windows when the pollen count is high. 
• Stop smoking, if you haven’t already. 
• Get the seasonal flu vaccine, especially if illnesses make your asthma symptoms worse.

Develop an Action Plan

Your asthma action plan is a detailed guide to managing and treating your asthma symptoms. In addition to providing information for you, your healthcare providers, and family and friends on what to do during a mild, moderate, or severe asthma flare-up, an asthma action plan should include:

• Your medical history, including allergies and co-occurring medical conditions
• Contact information for your loved ones, the emergency department, your healthcare provider, and any other pertinent people
• Information about your medications, including the dose, frequency, and instructions on how to administer them in an emergency

Take Medication

Take your asthma medications on time and as prescribed. If you use a rescue inhaler, make sure to bring it with you everywhere you go. If your healthcare provider prescribes you preventive controller medications, take them even when you’re not having asthma symptoms. 

If you have co-occurring medical conditions, treating them can also help to ease your asthma symptoms. For example, many people with asthma also have GERD and obstructive sleep apnea (in which you stop and start breathing repeatedly during sleep).

Taking GERD medications, eating a GERD-friendly diet, and using a continuous positive airway pressure (CPAP) machine for sleep apnea can help you manage your asthma, as well.

Summary

Asthma is a chronic medical condition that causes symptoms like wheezing, coughing, shortness of breath, and chest tightness due to inflammation and narrowing of the airways in the lungs. Asthma flare-ups happen when asthma symptoms get worse.

Flare-ups can be mild, moderate, or severe. They are usually caused by common asthma triggers, such as pollutants, irritants, allergens, odors, stress, infections, illnesses, weather changes, and strong emotions.

To treat an asthma flare-up, you can take quick-relief asthma medications (usually through an inhaler) and if prescribed to you, oral corticosteroids or other medications that fight inflammation in asthma. If symptoms get worse, it’s important to seek emergency medical treatment.

You can prevent asthma flare-ups by avoiding triggers, creating an asthma action plan, and taking your asthma medication as prescribed.

A Word From Verywell

If your asthma symptoms get worse, it’s important to treat them right away. In severe cases, asthma can lead to respiratory failure, which can be fatal. Seek emergency help if your asthma flare-up is persistent or reaches the point where you feel it's out of control.