Asthma in Action

Updated May, 2021

Around 5.4 million people In the UK are currently diagnosed with asthma. About 8% of the population or one in every 12 adults and one in every 11 children. It is a chronic and potentially fatal disease. Around 1500 people die every year in the UK as a result of asthma. In this blog we will explain what asthma is, how to recognise the signs and symptoms and how it can be treated in a first aid setting. Asthma can’t be cured, but its symptoms can be controlled.

What is Asthma?

Asthma is a condition in which your airways narrow due to swelling and produce extra mucus, causing coughing, wheezing and shortness of breath.

Most people have specific triggers that set off their asthma. For some asthma is a minor nuisance. For other people it can be a major problem that get in the way of daily activities and may lead to life-threatening asthma attacks.

Asthmatics should always carry a blue ‘reliever’ inhaler with them. It should be kept nearby ready to use and should be in date.

How do asthma triggers bring on an attack?

Asthma sufferers have sensitive airways that react to a trigger. When they encounter a trigger, the airways react in three ways:

  1. The muscles around the walls of the airways tighten so that the airways become narrower.
  2. The lining of the airways becomes inflamed and starts to swell.
  3. Sticky mucus can sometimes build up, which can narrow the airways around the lungs. The tiny airways in the lungs are also blocked by this mucus making the lungs very inefficient and the casualty struggles to get them to work properly.

These reactions in the airways make it difficult to breathe and can lead to an asthma attack. 

Examples of Asthma Triggers:

  • Heavy exercise or physical exertion
  • Cold, damp, dusty or smoky environments
  • Stress or anxiety, especially for prolonged periods
  • Airborne substances, such as pollen, dust mites, mould spores, pet hairs
  • Respiratory infections, such as the common cold

What are signs and symptoms of an asthma attack?

Many people with asthma self-manage by using their inhaler. However, their triggers may overwhelm their ability to manage the condition or a new trigger may impact on them leading to what we call an asthma attack.

The signs and symptoms of an asthma attack are:

  • Their blue reliever inhaler isn’t working – or they need to use it much more over a 4 hour period
  • They wheeze or cough a lot or have a very tight chest
  • They are breathless and find it difficult to walk or talk, often not able to finish a sentence without taking a breath
  • Their breathing rate increases and they feel like they can’t get a breath into their lungs properly
A range of asthma inhalers and a spacer device.
Asthma inhalers come in different colours, designs and sizes. The blue one at the top is the emergency or ‘reliever’ inhaler. A spacer device is shown at the bottom – this improves the uptake of the asthma medicine.

What is the best thing to do when someone is having an asthma attack?

If someone is having an asthma attack, you should get them to:

  1. Sit upright
  2. Get away from the trigger 
  3. Stay calm 
  4. Use their inhaler
  5. Take long, deep breaths. This helps to slow down their breathing and prevent hyperventilation (Hyperventilation makes the condition worsen more quickly)
  6. Seek emergency medical help if their inhalers do not help

The duration of an asthma attack can vary, depending on what caused it and how long the airways have been inflamed. Mild episodes may last only a few minutes and can resolve spontaneously or may require use of the blue quick-acting reliever inhaler. More severe episodes can last for hours but should be recognised early and medical help sought quickly.

This asthma attack information is not for people on a SMART or MART regime, who will have their own action plan.

How do you tell if an asthma attack is severe or not?

Most asthmatics are very good at self-medicating. Some asthmatics and Outdoor First Aiders carry a Pulse oximeter This is a small device that fits onto the finger and measures heart rate but also oxygen level in the blood. (It is also a feature on some smart watches.) A decreasing oxygen level in the blood is a good indicator of the worsening of an asthmatic episode or attack.

An oximeter device on a finger
A pulse oximeter measures oxygen level in a casualty’s blood – a good indicator of an asthma condition. (Generally measured with the hand flat)

However, in an asthma attack, stress and anxiety may make the condition worse. Most asthmatics have a peak flow meter that they use to measure their lung’s ‘peak flow rate’. This is assessed at their annual review and a ‘best’ figure is marked in their asthma action plan. By comparing this to their peak flow rate during an episode or attack, we can determine how mild or severe the asthma attack is along with oxygen levels and other signs. If in doubt, phone 999 but this table is a guide to the changing signs and symptoms.

Stage of severity Breaths per minute Oxygen level
(measured with an oximeter)
Peak flow meter reading Other signs and symptoms What to do
‘Normal’Less than 25More than 94%Their ‘best’ achieved according to their asthma action planNone – having a good day!Nothing required
MildLess than 25More than 94%50-75% of their best peak flow (from their asthma plan card)Able to speak a full sentence without stoppingUse inhaler
SevereMore than 25Less than 92%33-50% of their best peak flowIncreased heart rate, unable to speak in whole sentencesUse inhaler, monitor, reassure and phone 999/112
Life threateningMore than 25Less than 92%Less than 33% of their best peak flow Increased heart rate, unable to speak in whole sentences, exhaustion, blue lips, silent chestPhone 999/112
Near fatalNot visibleSlips into unconsciousness; blue lipsPhone 999/112, be prepared to do CPR

What is the correct way to use an asthma inhaler?

For an explanation on how to use an inhaler in more detail in an emergency situation, you can refer to our video on the subject.

How to manage asthma:

There are several steps people can take to cut their risk of asthma triggers causing an asthma attack:

  1. Be alert to the potential triggers at different times of the year (pollen etc) or in different situations such as moving from warm indoor spaces to very cold outdoor spaces.
  2. Use a preventer inhaler regularly – A preventer inhaler is the non-blue inhaler that works away in the background to help inflammation and sensitivity in your airways. Taking it every day means there’s less chance of a reaction if they come into contact with any triggers. 
  3. Write an Asthma action plan with a GP or Nurse – You can download an asthma action plan here. This will helps identify triggers and know what to do during an attack.
  4. Go an Asthma review each year – An ‘asthma review’ gives them and their GP or asthma nurse a chance to make sure their written asthma action plan is up to date. It also gives them the opportunity to ask more questions and learn how to spot the early signs of an attack or potential triggers at different times of the year.
  5. Check their doses – Make sure their medicine is at the right dose and that their inhalers are in date.
  6. Check their inhaler technique – A change of inhaler technique could help them manage their asthma better. They can discuss this at any time with their doctor or at their annual review. Different inhalers work better for different people. Sometimes, spacers or masks may help taking the dosage more effective as well as slow down their breathing rate.

Is asthma the same as COPD?

COPD is Chronic Obstructive Pulmonary Disease. It is progressive and irreversible and caused by damage to the lungs, most often by smoking or work related causes such as dust. It may manifest as Chronic Bronchitis or Emphysema. With both of these, gas exchange in the lungs is impaired and often a daily wheezy cough is a typical sign along with an increased breathing rate. The breathing may be also be difficult or laboured. First aid treatment is similar to asthma with the use of inhalers but there is often the need to get further medical help as the casualty may need additional medication or different treatment methods through nebulisers or oxygen masks to aid their breathing. People with COPD need to manage their breathing every day whereas asthmatics, although they take inhalers every day, only need to use their emergency inhalers when a trigger sets off an attack.