An asthma attack is a sudden narrowing of the airways from muscle spasm, swelling and mucus. Most attacks respond to quick treatment, but a severe attack can be life-threatening.
Key symptoms
- Wheeze, cough and chest tightness
- Shortness of breath, worse at night or with triggers
- Trouble speaking in full sentences in severe attacks
What you find on exam
- Fast breathing, use of neck muscles
- Wheeze on both sides; a quiet chest is a danger sign
- Oxygen saturation, heart rate
- Peak flow compared with the patient's best
Tests
- Peak flow before and after treatment
- Oxygen saturation; blood gas if severe or tiring
- Chest X-ray only if pneumonia, pneumothorax or no response is suspected
Treatment basics
- Oxygen to the target saturation
- Inhaled albuterol, repeated or continuous; add ipratropium if moderate to severe
- Steroids early, by mouth or IV
- Severe: IV magnesium; epinephrine if life-threatening
- Before discharge: check inhaler technique and give a written action plan
Red flags
- Silent chest, drowsiness or confusion
- Cannot speak, saturation falling
- Past ICU stay or intubation for asthma
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.