Asthma Attack


  • Your child is having an asthma attack
  • Use this guide only if a doctor has told you your child has asthma


  • Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
  • Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound.  You can hear it best when your child is breathing out.

Causes (Triggers) of Asthma Attacks

  • Infections that affect breathing (like colds or the flu)
  • Pollens
  • Animals (like cats)
  • Tobacco smoke
  • Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
  • Asthma attacks caused by food allergy can be life-threatening

Asthma Attack Scale

  • Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard. (GREEN Zone: Peak Flow Rate 80-100% of normal rate)
  • Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. (YELLOW Zone: Peak Flow Rate 50-80% of normal rate)
  • Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. (RED Zone: Peak Flow Rate less than 50% of normal rate)

First Aid for Anaphylaxis - Epinephrine

  • Anaphylaxis is a life-threatening allergic reaction.
  • If you have epinephrine (such as Epi-pen), give it now.
  • Do this while calling 911.
  • Over 66 pounds (30 kg): Give 0.3 mg. Epi-Pen.
  • 33-66 pound (15-30 kg): Give 0.15 mg. Epi-Pen Jr.
  • Less than 33 pounds (15 kg): Give dose advised by your doctor.
  • Give the shot into the upper outer thigh in the leg straight down.
  • Can be given through clothing if needed.
  • Albuterol inhaler: After giving the Epi-pen, give 4 puffs from your asthma inhaler.
  • Benadryl: After giving the Epi-pen, also give Benadryl by mouth. Do this if your child is able to swallow.

When to Call Us for Asthma Attack

Call 911 Now (your child may need an ambulance) If

  • Wheezing and life-threatening allergic reaction to similar substance in the past
  • Starts to wheeze suddenly after taking medicine, an allergic food or bee sting
  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency

Call Us Now (night or day) If

  • Your child looks or acts very sick
  • Looks like he did when hospitalized before with asthma
  • Lips or face have turned bluish during coughing
  • Trouble breathing not gone 20 minutes after neb or inhaler
  • Peak flow rate less than 50% of normal rate (RED Zone)
  • Peak flow rate 50-80% of normal rate after using neb or inhaler (YELLOW Zone)
  • Wheezing (heard across the room) not gone 20 minutes after using neb or inhaler
  • Nonstop coughing not improved after using neb or inhaler
  • Severe chest pain
  • Need to use asthma medicine (neb or inhaler) more often than every 4 hours
  • Fever over 104° F (40° C)
  • You think your child needs to be seen urgently

Call Us During Weekday Office Hours If

  • You have other questions or concerns
  • Don't have written asthma action plan from your doctor
  • Use an inhaler, but don't have a spacer
  • Miss more than 1 day of school per month for asthma
  • Asthma limits exercise or sports
  • Asthma attacks wake child up from sleep
  • Use more than 1 inhaler per month
  • No asthma check-up in over 1 year

Parent Care at Home If

  • Mild asthma attack


What You Should Know:
  • Over 10% of children have asthma.
  • Your child's asthma can flare up at any time.
  • When you are away from your home, always take your child's medicines with you.
  • The sooner you start treatment, the faster your child will feel better.
  • Here is some care advice that should help.
Asthma Quick-Relief Medicine:
  • Your child's quick-relief (rescue) medicine is albuterol or xopenex.
  • Start it at the first sign of any wheezing, shortness of breath or hard coughing.
  • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
  • Repeat it every 4 hours if your child is having any asthma symptoms.
  • Never give it more often than 4 hours without talking with your child's doctor.
  • Coughing. The best "cough med" for a child with asthma is always the asthma medicine. (Caution: don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough.)
  • Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
  • Use the medicine until your child has not wheezed or coughed for 48 hours.
  • Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
Asthma Controller Medicine:
  • Your child may have been told to use a controller drug. Examples are inhaled steroids or cromolyn.
  • During asthma attacks, keep giving this medicine to your child as ordered.
Hay Fever:
  • For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
  • Try to get your child to drink lots of fluids.
  • Goal: Keep your child well hydrated.
  • Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
Avoid or Remove Allergens:
  • Shower to remove pollens or other allergens from the body and hair.
  • Avoid known causes of asthma attacks (such as smoke or cats).
  • Do not take part in sports during the attack.
What to Expect:
  • If treatment is started early, most asthma attacks are quickly brought under control.
  • All wheezing should be gone by 5 days.
Call Your Doctor If:
  • Trouble breathing occurs
  • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
  • Wheezing lasts over 24 hours
  • Your child becomes worse
How to Use a Dry Powder Inhaler

How to Use a MDI

How to Use a MDI with Spacer

And remember, contact us if your child develops any of the "Call Us" symptoms.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Copyright 1994-2013 Barton D. Schmitt, M.D.