A severe asthma attack can be a life threatening event. Its symptoms may be similar to those of a mild attack at first, but they do not improve with quick-relief medications.

Not every asthma attack is the same. While mild and moderate asthma attacks typically respond to home treatments and do not last for long, severe asthma attacks require emergency medical treatment. Severe asthma attacks may warrant hospitalization.

This article will review severe asthma attacks, their symptoms, causes, and prevention. It will also include how doctors diagnose and treat them and what to do in case of a suspected severe asthma attack.

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A severe asthma attack — also known as acute severe asthma — is when asthma symptoms seriously and progressively worsen. Severe asthma attacks can start with symptoms similar to milder attacks.

Not responding to inhaled bronchodilators — medications that open the airways — is a sign a person has severe asthma. Mild or moderate asthma attacks typically respond to these treatments within a few minutes.

Severe asthma attacks require emergency care.

Learn more about severe asthma.

Symptoms of a severe asthma attack may start similarly to milder attacks, but then, begin to worsen.

Some early signs include:

  • wheezing
  • shortness of breath
  • breathing difficulty
  • chest tightness
  • severe coughing
  • itchiness
  • fatigue
  • a runny nose

During a severe asthma attack, breathing difficulties, which cause reduced oxygen intake, can lead to additional symptoms, such as:

  • mental confusion
  • chest pain
  • a rapid pulse
  • difficulties talking
  • lips, nails, or face discoloration
  • extreme anxiety and restlessness
  • restriction in the chest
  • drowsiness
  • dizziness

Initially, a person may use inhalers and nebulized medications for an asthma attack. However, these measures do not improve a severe asthma attack.

If a person experiences an asthma attack and their symptoms worsen or do not go away after using quick-relief medications for about 10 minutes, they must immediately seek emergency help.

A hand-held, portable device called a peak expiratory flow (PEF) can be helpful. It measures how quickly a person can blow air out of the lungs. Although there is no single parameter doctors use to define a severe asthma attack, if a person has a PEF score of 50% or lower, this can be a sign of a severe asthma attack. They must contact emergency services immediately.

Severe asthma attacks may occur due to many factors, also known as asthma triggers. Not everyone with asthma has the same triggers. Exposure to a specific trigger can lead to inflammation of the airways and potentially, a severe asthma attack.

However, exposure to a trigger does not always mean a severe asthma attack will occur. Many people may develop only a mild or moderate attack.

Asthma triggers may include:

  • cold temperatures
  • dry air
  • dust mites
  • humidity
  • mold
  • animal dander
  • pollen
  • chemicals, including cleaning products
  • heartburn
  • perfumes
  • stress
  • smoke
  • certain medications
  • respiratory infections
  • cardiovascular or lung disease
  • hormonal changes

At the hospital, doctors may perform several tests to check the health of the lungs to determine how severe the inflammation is. These may include:

  • chest X-ray, which can determine if there is an infection or other contributory causes of shortness of breath
  • pulse oximetry, which measures how much oxygen is in the blood
  • a PEF test, a score of 50% or lower may indicate a severe asthma attack

Doctors may administer one, or a combination, of the following medications to treat severe asthma attacks:

  • Corticosteroids, oral, intravenous (IV), or nebulized: These can help reduce and control inflammation.
  • Ipratropium (bromide), nebulized form: This is a potent bronchodilator that can widen the airways.
  • Beta2-agonist, a short-acting nebulized form: A person may use a beta2-agonist, such as salbutamol, to relax and dilate the airways.
  • Magnesium sulfate, via IV: This has an additional bronchodilator effect.

The healthcare team may also give oxygen by nasal cannula, mask, or noninvasive devices, including continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) devices.

In people with life threatening cases, intubation with the use of a mechanical ventilator may be necessary.

Is it possible to prevent a severe asthma attack?

There is no way to prevent asthma attacks completely. However, knowing what typically triggers asthma episodes and avoiding them may help people reduce their risk of experiencing asthma attacks.

A healthcare professional can help people develop an action plan for their asthma.

Learn about asthma action plans.

Severe asthma attacks are life threatening and require immediate medical treatment. Left untreated, a severe asthma attack can cause death. The Centers for Disease Control and Prevention (CDC) reports that in 2021, 3,517 people died in the United States due to asthma.

Still, with prompt and appropriate treatment, people can survive a severe asthma attack.

Severe asthma attacks can cause life threatening symptoms and require immediate medical treatment. Symptoms, which may start mild, can develop into worsening chest tightness, fast breathing, and trouble breathing.

If a person suspects they may be having a severe asthma attack, they must contact emergency services immediately.