A person may experience asthma exacerbations or attacks, during which their asthma worsens, or new symptoms occur.

Asthma is a chronic respiratory condition that causes inflammation and narrowing of the airways.

The symptoms of asthma exacerbations include coughing, wheezing, chest tightness, and shortness of breath. Some people may also experience rapid breathing or gasping for air during sleep.

Doctors will usually work with an individual to create an asthma action plan to help them manage their condition. This action plan will list all of their medications and confirm when to use them. It will also include the signs of an oncoming asthma attack and explain what action to take and when to seek medical care.

Keep reading to learn more about asthma exacerbations, including the symptoms, treatment options, and when to seek emergency care.

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Asthma exacerbations are progressive increases in asthma symptoms, including coughing, shortness of breath, or wheezing. These increases are significant enough that the individual needs to change their treatment methods or current asthma action plan.

Exacerbations are different than difficult-to-control asthma. If an individual has asthma, their doctor may use a measurement of airflow called diurnal variability to assess the condition. Diurnal variability measures the difference between a person’s highest and lowest scores on a peak expiratory flow rate test, and it is a key marker of poor asthma control. Although diurnal variability changes in people who find it difficult to control their asthma, it might not change during an exacerbation.

Asthma exacerbations frequently affect people who have severe asthma, and they usually have a trigger. Viral respiratory infections, such as the human rhinovirus subtypes A and C, are the most common causes of asthma exacerbations in adults and children.

However, having a respiratory infection does not necessarily mean that a person will experience an asthma exacerbation.

Other possible triggers of asthma exacerbations include:

  • bacterial infections
  • allergies
  • defective antiviral immunity
  • allergen exposure
  • pollutants, such as tobacco smoke and particulate matter
  • occupational exposures

The signs and symptoms of asthma exacerbations include:

  • breathlessness
  • coughing
  • wheezing
  • chest tightness
  • agitation
  • increased respiratory rate
  • increased pulse rate
  • decreased lung function

The measurements that doctors use to determine lung function include:

  • forced expiratory volume
  • peak respiratory flow
  • partial pressure of oxygen
  • partial pressure of carbon dioxide
  • arterial oxygen saturation

Doctors perform a spirometry test to measure these qualities. The test involves using a spirometer to calculate how much air someone inhales and exhales and how quickly they exhale.

The primary goal of asthma treatment is to control an individual’s symptoms and prevent exacerbations. However, although it is possible to reduce the frequency of exacerbations, even the best treatment and management may not prevent them entirely.

Asthma exacerbations can occur even if someone has a solid treatment regimen. Due to this, doctors need to identify any people who may be at risk and have a management plan in place for them to use should they experience an asthma exacerbation.

The best course of action for minimizing exacerbations is early treatment and management, including:

  • recognition of early signs and symptoms of the condition worsening
  • an asthma action plan
  • removal of the environmental factor causing the exacerbation
  • prompt communication between the individual and their doctor
  • medication, such as preventive and rescue inhalers

Appropriate drugs for asthma exacerbations include inhaled corticosteroids (ICS) and a combination of ICS treatment and long-acting beta-agonists. People may take these medications orally.

Learn more about asthma rescue inhalers here.

Doctors use a measurement called the percent predicted passive expiratory volume or forced expiratory volume to classify the exacerbation as mild, moderate, severe, or life threatening. It measures the amount of air that an individual breathes out while resting and then while forcing out as much air as possible.

The severity of an individual’s exacerbation will determine the treatment options. Most of the time, if someone has a mild exacerbation, they can manage the treatment at home. However, a person may need to seek emergency medical care for a more severe exacerbation.

Individuals with one or more risk factors for asthma-related death may need emergency care, as may children, who have an increased risk of complications during an asthma exacerbation. These individuals should get medical help immediately if their asthma is worsening.

The risk factors for asthma-related death include:

  • a previous severe exacerbation
  • three or more emergency department (ED) visits for asthma in a year
  • two or more hospitalizations for asthma in a year
  • difficulty recognizing asthma symptoms
  • hospitalization or an ED visit for asthma in the past month

Infants have an increased risk because their lung function and anatomy differ from those of adults. They need a different approach to diagnosis and treatment, which qualified healthcare professionals should complete in a healthcare setting.

Anyone experiencing severe exacerbations should also seek emergency care, as the situation could be life threatening. People with severe asthma exacerbations need urgent care and treatment.

Doctors may carry out a series of lung function tests to measure how the individual progresses and improves. These results help doctors administer appropriate treatment and monitor individuals to ensure that their condition does not deteriorate.

People with severe asthma are at risk of a higher frequency of exacerbations and hospitalization. These individuals also tend to require intensive post-exacerbation management.

Asthma exacerbations are progressive increases in asthma symptoms, including coughing, wheezing, and shortness of breath. Viral respiratory infections are a common risk factor for asthma exacerbations.

After diagnosing someone with asthma, a doctor should work with them to create an asthma action plan. These plans outline the signs and symptoms of an asthma exacerbation, helping the individual recognize when they are having an exacerbation and understand the steps to take.

The severity of the exacerbation will determine whether an individual can treat themself at home or whether they require medical care. Children and people with additional risk factors during an exacerbation will need to receive emergency medical attention so that a doctor can closely monitor them.

Asthma exacerbations can be severe, especially in individuals at high risk. However, an effective asthma action plan helps streamline the treatment that someone needs when they experience an exacerbation.