How to manage an asthma emergency

If you're on the right treatment and are following your written Asthma Action Plan, your chances of having an asthma attack will be greatly reduced.

If you develop an asthma attack, then a reliever medicine will usually help to relieve your asthma symptoms.

However, sometimes an asthma attack is severe and may not improve even after using a reliever medicine. This is an asthma emergency and requires urgent first aid.

Call 000 for an ambulance immediately if you or someone else is having a severe asthma attack and a reliever medicine is not helping.

Quick action may help prevent an asthma attack from becoming an asthma emergency.

Download or print these asthma first aid fact sheets from the National Asthma Council Australia:

Asthma first aid — the 4x4x4 plan

The 4x4x4 plan is the standard asthma first aid procedure to use when an adult or child has the symptoms of a severe asthma attack.

Step 1

  • Sit the person up
  • Talk to them in a calm, reassuring voice
  • Stay with the person
  • Refer to their Asthma Action Plan

Step 2

A Symbicort or Bricanyl inhaler may be used instead if the person usually uses one of these medicines, or if there is no reliever medicine available, but only in people over 12 years of age. If Symbicort or Bricanyl is used, you must follow the SMART protocol outlined below.

  • Use a spacer if available to help the medicine work more effectively

If a spacer is not available, it is acceptable to use the reliever inhaler by itself, and following proper inhaler techniques as closely as possible.

  • Shake the puffer and give a single puff from the inhaler into the spacer
  • Get the person to take 4 breaths from the spacer
  • Repeat this 4 times, for 4 puffs in total

Step 3

  • Wait for 4 minutes
  • If there is no improvement in the person’s symptoms, repeat Step 2

Step 4

  • If there is still no improvement in the person's symptoms, call an ambulance (000)
  • Tell the operator that the person is having an asthma attack
  • Keep giving puffs into the spacer (one puff at a time) and get the person to take 4 breaths from the spacer per puff. Repeat this 4 times every 4 minutes while you await the ambulance.

SMART first aid (for Symbicort or Bricanyl inhalers)

The following first aid procedure should be used in an asthma emergency for a person who is 12 years or older and who already uses Symbicort (or Bricanyl) regularly to manage their asthma.

Step 1

  • Sit the person up
  • Talk to them in a calm, reassuring voice
  • Stay with the person
  • Refer to their Asthma Action Plan

Step 2

  • Give the person a Symbicort Turbuhaler

A Symbicort or Bricanyl inhaler may be used instead if the person usually uses one of these medicines, or if there is no reliever medicine available, but only in people over 12 years of age.

  • Give 2 separate inhalations of either Symbicort or Bricanyl to the person

Step 3

  • Wait for 1-3 minutes
  • If there is no improvement in the person’s symptoms, give the person 1 further inhalation of Symbicort or Bricanyl

Step 4

  • If there is still no improvement in the person's symptoms, call an ambulance (000)
  • Tell the operator that the person is having an asthma attack
  • Keep giving the person inhalations of either Symbicort or Bricanyl while you await the ambulance:
    • If you are using Symbicort, give 1 dose every 4 minutes for up to 3 more doses
    • If you are using Bricanyl, give 1 dose every four minutes until the ambulance arrives.

Preventing asthma emergencies

If you don’t already have one, ask your doctor for a written Asthma Action Plan to help you manage your symptoms and recognise worsening asthma.

Your Asthma Action Plan records how to use your medicines when your asthma is under control, and what to do if you have an asthma attack.

See you doctor regularly to review your Asthma Action Plan and keep it up to date. Make sure your doctor know whenever your asthma symptoms are getting worse.

You shouldn't need to use your reliever medicine on more than 2 days per week.

See your doctor if you need to use it more often or if it’s not working as well as it usually does. This is a sign that your asthma is not well controlled, or is worsening.

Find out more

References
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The relevant consumer medicine information (CMI) and product information (PI) have been consulted for every medicine discussed.

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