Acute Severe Asthma

What is acute severe asthma?

Acute severe asthma is a sudden severe asthma attack. And it doesn't get better after taking asthma medicine. This type of asthma is life-threatening. If you think someone is having a severe asthma attack, call 911 right away. The main treatment is done in the emergency room and the hospital. But early treatment done by first responders can save lives.

What causes acute severe asthma?

Any person with asthma can have an acute severe flare-up. Causes can include:

  • Having an infection, such as a cold or sinus infection

  • Having a severe allergic reaction

  • Inhaling irritants like fumes from bleach or smoke

  • Not taking prescribed medicine

  • Exercising

Who is at risk for acute severe asthma?

You may be at risk for acute severe asthma if you:

  • Have had a severe asthma attack in the past

  • Have trouble noticing when you are having asthma symptoms. Or how bad those symptoms are.

  • Have asthma attacks even when using oral glucocorticoids

  • Don’t take your asthma medicines as prescribed

  • Smoke

  • Have other health problems, such as depression, heart disease, or lung disease


What are the symptoms of acute severe asthma?

The symptoms of acute severe flare-ups often happen over hours or days. But they can come on faster. They are:

  • Trouble breathing and wheezing that gets worse

  • Fast breathing

  • Cough and chest tightness that gets worse

  • Inability to breathe when laying down

  • Trouble walking and talking

  • Sweating

  • Fast heart rate

  • Confusion or irritability


How is acute severe asthma diagnosed?

Acute severe asthma is life-threatening. So quick diagnosis is important. Call 911 right away f you think you or someone you know is having a severe asthma attack, call right away. Healthcare providers will ask about your symptoms. They will give you a physical exam. You may need these tests:

  • Peak expiratory flow. This test can gauge lung function.

  • Pulse oximetry. This test measures the level of oxygen in your body.

  • Chest X-ray. This test may be done in severe cases. Or it may be done if your healthcare provider thinks you may have some other health problem.


How is acute severe asthma treated?

Treatment for acute severe asthma is often done in a hospital. Your healthcare provider will focus on opening up your airways. And helping you breathe easier. You may need:

  • Medicines. Your healthcare provider will give you medicines to ease your symptoms. These may be inhaled or swallowed. Or given through an IV (intravenous) line.

  • Magnesium sulfate. This may be used if other medicines don’t work. It’s given through an IV.

  • Supplemental oxygen. This helps raise oxygen levels in your body.

  • Ventilator. In very severe cases, you may be put on a machine to help you breathe. This is if other treatments don't work.


What can I do to prevent severe acute asthma?

To help prevent acute severe flare-ups, be sure to:

  • Know and stay away from those things that cause your flare-ups.

  • Try to stay away from people who are sick.

  • Wash your hands often.

  • Talk with your healthcare provider about vaccines you should get.

  • If you have severe allergies, go to an allergist.

  • If you smoke, get help to quit. Stay away from secondhand. And thirdhand smoke, too.

  • Take asthma medicines as directed. This includes your long-term control medicines. It's important to take them even if you feel like your asthma is under control.

  • If exercise is a trigger, use your quick-relief medicine before you are active, if directed to do so by your healthcare provider. Keep an inhaler in your purse, gym bag, or backpack.

  • Develop an Asthma Action Plan with your provider. Share the plan with your family members and close friends so they know when to call 911.


When should I call my healthcare provider?

Call 911 right away if you are having an asthma attack and your symptoms don’t get better after you take your quick-relief or rescue medicines.

Key points about acute severe asthma


  • Acute severe asthma is a sudden severe asthma attack that doesn't get better after taking asthma medicine.

  • This type of asthma is life-threatening. Call 911 right away if you think you or someone you know is having a severe asthma attack.

  • Acute severe asthma can have various causes. These include an infection or an allergic reaction.

  • Treatment may include medicines and oxygen.

  • You can prevent acute severe asthma by knowing and staying away from what triggers your asthma. And taking medicines as directed.

  • An Asthma Action Plan can help you, your family, and friends know what treatments are needed and when to call 911.


Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Dan Brennan MD
Online Medical Reviewer: Deborah Pedersen MD
Online Medical Reviewer: Jessica Gotwals RN BSN MPH
Date Last Reviewed: 3/1/2023
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