What Is Acute Severe Asthma?

Acute severe asthma is a serious and potentially life-threatening asthma emergency [1]. It happens when asthma symptoms suddenly become very intense and do not improve with the usual reliever inhaler (usually a blue inhaler). This condition requires urgent medical attention and can lead to hospital admission if not treated quickly.

What causes acute severe asthma?

It usually happens when asthma is not well controlled or when someone is exposed to a strong trigger. Common causes include:

Respiratory infections like colds or flu
Exposure to allergens such as pollen, pet fur, or dust mites
Cold weather or sudden changes in temperature
Smoking or breathing in smoke or fumes
Missing doses of preventer medication

What are the symptoms of acute severe asthma?

Symptoms are much worse than usual and may include:

Extreme breathlessness – struggling to speak or finish a sentence
Very fast or shallow breathing
Wheezing that may be loud or suddenly stop (which can be a dangerous sign)
Chest tightness that doesn’t ease with medication
Rapid heartbeat
Lips or fingers turning blue or grey (a sign of low oxygen)
Feeling very anxious, drowsy, or confused

How is acute severe asthma different from a regular asthma attack?

A regular asthma attack usually gets better with a reliever inhaler. Acute severe asthma does not improve even after 10 puffs of the reliever inhaler and can quickly become dangerous if emergency treatment is not given. It is a medical emergency and should not be ignored.

What should you do during an acute severe asthma attack?

If you or someone else is having symptoms of acute severe asthma:

Sit upright and stay as calm as possible

Use the reliever inhaler: take one puff every 30 to 60 seconds, up to 10 puffs

Call 999 immediately – do not wait to see if it gets better

If there is no improvement after 10 puffs, repeat the inhaler every 15 minutes while waiting for help

How is acute severe asthma treated in hospital?

Treatment may include [2]:

High-dose reliever medicine through a nebuliser or inhaler with spacer
Oxygen to help with breathing
Steroid tablets or injections to reduce airway inflammation
Other emergency treatments if needed to stabilise breathing

Can acute severe asthma be prevented?

Yes, in many cases. Prevention includes:

Taking your preventer inhaler daily, even when you feel well
Keeping an up-to-date asthma action plan
Avoiding known triggers wherever possible
Having regular asthma reviews with your GP or nurse

Key Takeaways

Acute severe asthma is a medical emergency where symptoms do not improve with usual treatment.
It causes severe breathlessness, chest tightness, and can be life-threatening if not treated quickly.
Call 999 straight away if symptoms don’t improve after 10 puffs of a reliever inhaler.
Hospital treatment may include oxygen, steroids, and nebulisers to help breathing.
Daily preventer medication and a personalised asthma action plan can help reduce your risk.

Reminder: Never ignore worsening asthma symptoms. If you use your reliever inhaler more often or feel your breathing is out of control, seek medical advice immediately. Early action saves lives.

Sources

[1] Kostakou E, Kaniaris E, Filiou E, Vasileiadis I, Katsaounou P, Tzortzaki E, Koulouris N, Koutsoukou A, Rovina N. Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management. J Clin Med. 2019 Aug 22;8(9):1283. doi: 10.3390/jcm8091283. PMID: 31443563; PMCID: PMC6780340.

[2] Asthma, acute | Treatment summaries - BNF - NICE