What Is an Asthma Exacerbation?

An asthma exacerbation, also known as an asthma flare-up or worsening of asthma, is when symptoms become more intense or difficult to control. It can happen suddenly or build up over time. Some exacerbations are mild, but others can be severe and may need urgent medical attention [1].

What causes an asthma exacerbation?

Exacerbations are often triggered by things that irritate the lungs. Common triggers include:

Colds or viral infections
Allergens like pollen, dust mites, or pet dander
Smoke, strong smells, or pollution
Cold or damp weather
Exercise without proper asthma preparation
Stress or strong emotions
Not taking asthma medication as prescribed

What are the signs of an asthma exacerbation?

Signs that your asthma is getting worse include:

Increased coughing, especially at night
More frequent wheezing
Shortness of breath that’s harder to control
Tightness in the chest
Needing your reliever inhaler (blue inhaler) more often
Trouble sleeping due to breathing problems

What should you do during an asthma exacerbation?

If you notice your symptoms are worsening:

Follow your asthma action plan if you have one.

Use your reliever inhaler – take one puff every 30–60 seconds, up to 10 puffs.

Stay calm and sit upright to help your breathing.

If symptoms don't improve after 10 puffs, call 999 immediately.

Repeat 10 puffs after 15 minutes if the ambulance hasn’t arrived.

When is an asthma exacerbation an emergency?

Seek urgent medical help if you:

Are too breathless to speak, eat, or sleep
Notice your lips or face turning blue
Feel very drowsy or confused
Have no relief after using your reliever inhaler

How can asthma exacerbations be prevented?

To lower your risk of flare-ups:

Take your preventer inhaler every day as prescribed
Have regular asthma reviews with your GP or nurse
Avoid known triggers when possible
Get vaccinated against flu and COVID-19
Keep your asthma action plan up to date

Who is most at risk of an asthma exacerbation?

You may be more at risk if:

Your asthma isn’t well controlled
You’ve had an asthma attack in the past year
You use your reliever inhaler more than three times a week
You don’t use your preventer inhaler regularly

Key Takeaways

An asthma exacerbation is a flare-up of symptoms that can range from mild to life-threatening.
Triggers include colds, allergens, pollution, and missed medication.
Symptoms include more coughing, wheezing, breathlessness, and needing your inhaler more often.
Always follow your asthma action plan and call 999 if symptoms don’t improve with your reliever inhaler.
Prevention includes daily treatment, avoiding triggers, and regular asthma check-ups.

Reminder: Never ignore worsening asthma symptoms. Early action can help prevent serious complications and save lives.

Sources

[1] Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA Jr, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C. Asthma outcomes: exacerbations. J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S34-48. doi: 10.1016/j.jaci.2011.12.983. PMID: 22386508; PMCID: PMC3595577.