Severe asthma attack: symptoms, causes and treatment

Severe asthma is a lung disease that does not respond well to typical asthma treatments. It can become serious and even fatal if left untreated. Asthma is typically triggered by allergens like dust, pets, and cleaning products, and some less common triggers like weather changes and emotional distress.

This article presents a list of asthma triggers, symptoms to look for in a severe asthma attack, and how severe asthma is diagnosed and treated in a hospital setting.

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What are the symptoms of a severe asthma attack?

Asthma is known as a progressive disease, which means that it starts with mild symptoms but can become severe over time. It is caused by inflammation or swelling of the airways, which makes it difficult for air to pass through.

Symptoms of severe asthma can vary from person to person, but the following signs may indicate a severe asthma attack:

  • Cough, especially in the morning and at night
  • Tightness in the chest
  • Shortness of breath
  • wheezing
  • Difficulty speaking
  • Blue lips or nails
  • Feeling confused or agitated
  • Symptoms that do not improve with medication

Asthma attacks are usually treated with quick-relieving medication that a person breathes through a device called a rescue inhaler. If asthma symptoms do not improve with the use of this or other medications, it could be a sign that asthma is severe.

Prevalence of severe asthma

Although severe asthma accounts for less than 10% of people with asthma, there are more than 500,000 hospitalizations for severe asthma attacks in the United States each year.

What are the causes of a severe asthma attack?

Severe asthma attacks usually occur when a person is exposed to an allergen. It’s important to remember that different people have different triggers. Therefore, making a plan to identify your own can help reduce the frequency of severe asthma attacks.

The most common allergens that trigger asthma attacks include:

  • Tobacco smoke: According to the Centers for Disease Control and Prevention (CDC), 1 in 5 people with asthma smoke, despite the fact that tobacco smoke is known to trigger asthma attacks. Second-hand smoke, often called second-hand smoke, can also exacerbate asthma symptoms.
  • MitesMore specifically, it is believed that the gut of dust mites contains digestive enzymes that can trigger asthma symptoms.
  • Air pollution: Air pollution is one of the most difficult triggers to avoid because there is no way for an individual to control the air around them. However, using maintenance therapy can help reduce the risk of asthma attacks from air pollution.
  • Pests: Parasites include creatures such as cockroaches or rodents. These types of allergens are typically found in homes in urban areas and can be minimized by keeping the home clean to avoid attracting those unwanted guests.
  • Pets: Not to be confused with “pests”, pets can trigger asthma attacks in some people. The most common household pets are cats and dogs, with cats being more allergenic than dogs.
  • Mold: Mold inside and outside can contribute to asthma symptoms. Mold is usually found in damp areas, so identifying spaces inside and outside the home that can develop mold can help you avoid mold-triggered asthma attacks.
  • Cleaning products and disinfectants: These common household items can trigger asthma attacks. The Environmental Protection Agency (EPA) has a “Safer Choice” program that can help you choose products that are safer for you and your family.

People with severe asthma are at greater risk of having asthma attacks on a regular basis. Severe asthma may not respond well to regular asthma treatment, so identifying your own triggers and trying to avoid them is crucial.

Less common triggers

The triggers listed above are the most common, but there are many less common triggers that could also induce a severe asthma attack. Colds and flu, sinus problems, strenuous exercise, weather changes (especially cold weather), as well as stress and emotional distress can all affect asthma symptoms.

How is a severe asthma attack diagnosed?

A healthcare professional will do a lung function test to determine the severity of your asthma. There are different types of lung function tests that use different types of devices to measure your air flow, including:

  • Spirometry: During spirometry test, the patient breathes into a tube attached to a laptop computer or machine called a spirometer. As you breathe, the spirometer will measure the amount and speed at which air is coming in and out. You can expect your provider to do this test before and after taking a medicine to open your airways, called a bronchodilator, to see if there is any improvement with the medicine.
  • Peak expiratory flow (PEF): Peak flow measures how much air you can forcefully exhale. This form of measurement is useful for monitoring severity, but is not used for diagnosing asthma.
  • Fractionated expired nitrogen monoxide (FeNo): Asthma causes inflammation in the lungs and produces a substance called nitric oxide. This test measures the amount of nitric oxide to determine the amount of inflammation in the lungs.
  • Provocation: During a challenge test, a healthcare professional will present different allergens to see how your body reacts and how you react when drugs are given.

How is a severe asthma attack treated in the hospital?

If you have difficulty breathing that does not improve with home treatment, see a doctor.

Treatment for asthma in the hospital might include typical home asthma medications combined with additional treatments such as supplemental oxygen, bronchodilators, and corticosteroids.

Some cases of asthma are so severe that a healthcare professional might recommend a procedure called bronchial thermoplasty. which uses heat to soften the airways that constrict during an asthma attack.

The length of hospital stay may vary from person to person. Some people with severe asthma are treated in the emergency room but are never admitted to the hospital. Regardless of admission, anyone treated in a hospital will be discharged home with instructions on how to treat their asthma at home.

Discharge instructions following an asthma attack will advise the patient to avoid allergy triggers and to follow up with their provider to adjust the asthma plan as needed. The instructions could also include additional medications, such as oral corticosteroids, to treat and prevent future attacks.


Severe asthma is serious and can be life threatening. It is recommended that people with asthma work with their healthcare provider to identify their triggers and avoid them if possible. If the triggers cannot be avoided or if a severe asthma attack occurs, there are treatment options that may require hospitalization.

A word from Verywell

Asthma can have a huge impact on a person’s quality of life, especially if it is severe. You can help yourself cope with severe asthma by being proactive. Develop an asthma plan with your health care provider to identify triggers and minimize the risk of an asthma attack. An effective treatment plan can help you live well with the disease.

Frequently Asked Questions

  • What is the difference between an asthma attack and a panic attack?

    Symptoms of an asthma attack and a panic attack can be similar. An asthma attack is often triggered by a specific allergen, while a panic attack is caused by severe anxiety.

  • Does time make asthma worse?

    Weather, especially cold, can exacerbate asthma symptoms. Hot weather can also have an impact on asthma symptoms.

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