Signs of an Attack

It can happen to all children: an asthma attack. Also called an asthma flare-up or an asthma episode, an attack is a worsening of asthma symptoms caused when muscles tighten around your child's airways, which are already swollen.

Milder attacks are usually more likely to occur, with airways opening up within several minutes to a few hours following treatment. Severe attacks can occur, but they happen less often. They could last longer and require prompt medical care.

But, it's important to identify and immediately treat even these attacks with milder symptoms to help stop severe episodes from occurring and keep asthma under control.


During the impending attack, the airway lining becomes further inflamed or swollen, and a thick layer of mucus is produced. This causes symptoms such as labored breathing, wheezing, coughing, and shortness of breath. Other symptoms include a pale and sweaty face; chest pressure; harsh wheezing when inhaling or exhaling; repeat coughing; tightened chest and neck muscles; chest pains; blue lips or fingernails; and trouble talking.

Failure to Treat

Sometime, individuals interpret the cessation of the wheezing as a sign that asthma symptoms have improved and fail to get immediate treatment. This could mean trouble ahead for your child: His breathing could become more strained, whether or not you can hear audible wheezing.

If your child uses a peak flow meter, his readings could drop — when compared with his personal best reading — into the “yellow zone” (caution) or “red zone” (danger) signs on his asthma action plan.

As his lungs continue to tighten, he will be unable to use his peak flow meter. His lungs could begin to shut off air movement to the point that wheezing stops. This is a dangerous sign that means he must be sent to the hospital at once. A bluish color will appear around the lips, indicating less oxygen in the blood. Without immediate treatment, he could become less responsive, more listless, and eventually, if not treated, possibly die.

Early Warning

Your child, though, may have early symptoms that indicate an asthma problem may be on its way. While they often won't stop your child from doing her day-to-day activities, they may be helpful in flagging that an asthma attack may occur if she doesn't take precautions now.

These early warning signs for your child include frequent throat clearing; coughing (particularly at night); shortness of breath; difficulty resting or sleeping; fatigue or weakness when exercising; constant feelings of tiredness; or signs of cold or allergies (sneezing, runny nose, cough, sore throat, and headache).

Signs also may include declining peak flow meter readings (as indicated by the asthma action plan) among children old enough to use it. By detecting these asthma signs, it's possible to stop an asthma attack or prevent one from getting worse.

In Case of Attack

Use your child's asthma action plan if she is experiencing an asthma attack and her symptoms fail to improve. If she falls into the plan's “red zone,” follow the emergency instructions regarding prompt medical attention. This may include calling your health care provider for more medication, such as oral steroids, going to the hospital, or calling an ambulance.


When an emergency occurs, you can set the tone for your child and prevent increased anxiety or panic. During an asthma attack, it's important that you remain calm and talk to him in a soothing, reassuring voice. While an attack can seem anxious and scary, your child is more likely to remain calm if you maintain your composure.

If your child is coughing or wheezing, your agitated or panicked voice could make her breathing even worse. Try to talk your child in a cool and collected manner. Tell her that you are there, and you're going to work through this with her step by step.

First, get her to use her quick-relief inhaler, and reassure her that the medicine will help. Urge her to physically relax — so her medicine will do its work. Consider holding her or using several massage techniques to calm her. (See Chapter 5.)

Bring up some other pleasant topics that will keep her mind off the attack. Offer her some water or juice, if possible, since fluids help keep the mucus moist and loose. Avoid cold liquids, though, since some children could become more symptomatic with them.

Also, consider using some video or audio recordings or books that she enjoys to redirect the stress she feels from the asthma attack. Soothing music can be helpful as can trying to control breathing by inhaling as slowly as tolerable and exhaling slowly through pursed lips.

If the quick-relief inhaler is not effective or does not last up to three or four hours before being needed again, consult your health care provider as other medication or treatments may be needed. Most importantly, have an asthma action plan ready to go before your child becomes ill so no time is wasted.

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