People with acute asthma experience breathing difficulty following exposure to something that irritates the lungs. This can include irritants, allergens, stress, or extreme weather.

People with asthma may experience chest tightness, shortness of breath, coughing, or wheezing. Treatment for an acute asthma attack involves quick-acting medications that open airways. However, if a person’s symptoms are very severe, they should seek immediate medical attention.

Keep reading to learn more about the causes, symptoms, diagnosis, prevention, and treatment of acute asthma.

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Asthma involves the inflammation and obstruction of the bronchial tubes, which allow air in and out of the lungs.

Acute asthma refers to an increase in symptoms that happen when the muscles surrounding the bronchial tubes tighten, which restricts air flow. It is also known as an asthma attack, or acute asthma exacerbation.

During an asthma attack, mucus production increases and can obstruct the airways, making it difficult to breathe. The attack may vary in severity and duration. Mild attacks may last a few minutes, while severe ones may last from hours to days.

Triggers for acute asthma exacerbation include common allergens, irritants, certain health conditions, and environmental factors.

Common allergens include:

  • grass, tree, or weed pollen
  • animal dander
  • dust mites
  • cockroaches

Common air irritants include:

  • chemical fumes
  • smoke
  • strong odors, such as perfume

Health condition triggers include:

  • sinusitis
  • flu
  • mild upper respiratory tract infections

Miscellaneous triggers include:

  • extreme weather conditions
  • strenuous exercise
  • strong emotions that affect normal breathing patterns

The symptoms of an asthma attack include:

  • coughing
  • chest tightness
  • shortness of breath
  • wheezing

The above symptoms can develop or worsen during an asthma attack. If the attack is severe, it may include:

  • inability to lie flat
  • sensation of air hunger
  • severe tiredness
  • insomnia
  • the need to use accessory muscles in the chest to assist with breathing
  • fast breathing
  • fast heartbeat
  • sweating, especially to an unusual extent
  • reduced alertness or consciousness
  • inability to complete sentences
  • anxiety or fearfulness
  • altered mental state
  • blue or white discoloration around the mouth

Doctors can diagnose most people with acute asthma based on medical history and a physical examination. The signs and symptoms of the condition often make the diagnosis obvious.

To determine the severity of a person’s asthma, doctors may order the below tests:

  • Spirometry: This is one of the most common lung tests. It measures the amount of air a person can inhale and exhale, as well as shows how fast they can exhale.
  • Peak airflow: A peak flow meter measures how well air moves in and out of the lungs. It can detect airway narrowing hours and days before symptoms appear.
  • FeNO tests: This stands for fractional exhaled nitric oxide. It measures nitric oxide in the breath, which indicates the amount of inflammation in the airways.
  • Provocation tests: Another name for these are trigger tests. They show the sensitivity of the lungs to irritants, exercise, and other factors that may act as triggers.

Aside from the above, doctors may order additional tests if they suspect a person has complications or other conditions that may make treatment more difficult. For instance, chest imaging is usually not necessary, but if an individual may have pneumonia, a doctor will order an X-ray.

The best way to prevent acute asthma attacks involves identifying and avoiding triggers, which differ among people with the condition.

The Centers for Disease Control and Prevention (CDC) recommend reducing exposure to the following common triggers:

Smoke

Tobacco smoke is unhealthy for anyone, particularly a person with asthma. Secondhand smoke, which is exposure to the smoking of another person, is also harmful. To avoid this irritant, a person should make their home a smoke-free zone.

Dust mites

The below measures can help a person avoid exposure to microscopic bugs called dust mites:

  • washing bedding weekly and drying it completely
  • buying allergen-proof mattresses and pillowcase covers
  • keeping relative humidity in the home between 30–50%
  • not using down-filled bedding or pillows
  • vacuuming rugs and floors with equipment that has a HEPA filter

Pests

These tips can help avoid cockroaches and other pests:

  • storing food in airtight containers
  • sealing cracks in baseboards, walls, and cabinets
  • storing trash in a closed container
  • cleaning crumbs, dishes, and spills promptly
  • keeping sinks, counters, and floors clean
  • not using pesticide sprays, because they can trigger asthma attacks

Mold

Mold can trigger an asthma attack even in people who do not have an allergy to it. This substance often grows in damp areas. The following practices can help reduce exposure:

  • drying damp surfaces within 24–48 hours
  • using a dehumidifier or air conditioner to maintain low indoor humidity
  • repairing water leaks quickly
  • emptying and cleaning refrigerator drip pans regularly
  • using detergent and water to scrub mold off of hard surfaces
  • opening the bathroom window or running an extractor fan when taking a shower

Pets

If a person suspects their pet is triggering asthma attacks, they may decide to find them another home. Short of this measure, strategies that can help include:

  • keeping pets out of the bedroom
  • bathing pets regularly
  • using an air purifier with a HEPA filter

Cleaning

Disinfectants can trigger asthma attacks, so to reduce exposure, consider:

  • staying away from the home when someone cleans and disinfects it
  • not overusing cleaning products
  • using alternative cleaning products that are less irritating, such as those in the EPA Safer Choice program
  • avoiding using bleach and products containing fragrances
  • opening windows when cleaning to improve ventilation

Outdoor pollution

Pollution comes from an array of sources, such as car exhaust, wildfires, and factories. Pay attention to air quality forecasts and plan outdoor activities when levels are low.

Learn more about air pollution and health.

Managing asthma involves:

  • identifying and avoiding triggers
  • taking medications the doctor prescribes
  • monitoring symptoms and reporting any changes to a doctor

For treatment of acute asthma, the American College of Allergy, Asthma, and Immunology recommends the use of quick-relief medications. They are available in the form of an inhaler, a device that delivers medicated mist to the lungs.

One quick-relief option is short-acting beta2 agonists, such as albuterol (Proventil). This drug relaxes the muscles lining the airways, which opens the airways and makes breathing easier.

Another quick-relief medication is anticholinergic bronchodilators, such as ipratropium (Atrovent). These block the nerve reflexes that constrict airways, which allow airways to stay open.

If a person’s symptoms linger or worsen, doctors may prescribe systemic corticosteroids. These are a class of drugs that reduce inflammation and mucus in the bronchial tubes. An example is triamcinolone (Kenalog).

People should seek immediate medical attention if their shortness of breath or coughing lingers or worsens.

According to the American Lung Association, people should call 911 or go to the emergency room or urgent care when:

  • their nails or lips are turning blue
  • they are breathing 30 or more times per minute
  • their nostrils are flaring during each inhalation
  • walking or talking at a normal pace is hard
  • the skin at the base of their throat or between their ribs appears stretched during each inhalation

Acute asthma happens when the muscles around bronchial tubes constrict, which narrows the air passages and makes breathing difficult.

The key means of prevention involves determining the factors that are triggering the attacks. Once a person identifies their triggers, they can be diligent in avoiding them.

When attacks are severe, they can cause fast breathing and heartbeat, and in serious cases, lead to a change in consciousness. Severe attacks can be life-threatening, so a person experiencing one should go to an emergency room quickly to receive treatment.