When to go to the Er For Asthama Attack

When to Go to the ER for an Asthma Attack

Reviewed byDr. Abdulla Kudrath, MD

Go to the ER for an asthma attack when your rescue inhaler isn’t helping or you need it more often than every 4 hours. Also go if you can’t speak in full sentences, your lips or nails look blue or gray, or the skin between your ribs pulls in with each breath. Call 911 if breathing is very hard.

Two quick checks can help you decide. If you use a peak flow meter, a reading under half of your personal best puts you in the red zone of your asthma action plan. The national asthma action plan from the NHLBI says to go to the hospital if you’re still in that zone after 15 minutes.

You can also count breaths for one full minute. According to the American Lung Association, a healthy adult at rest takes about 12 to 20. During a bad flare it can climb past 30. 

Call 911 instead of driving if you or the person with asthma:

  • Is too breathless to talk or walk
  • Has lips or a face turning blue or gray
  • Is drowsy, confused or hard to wake
  • Faints or collapses

These are the moments to seek emergency care for a severe asthma attack without delay. Paramedics can start treatment on the way.

What to Do While You Wait for Help

Whether you’re on your way to the ER or waiting for an ambulance, these steps help:

  • Sit upright or lean slightly forward. Lying down makes breathing harder.
  • Take your quick relief medicine exactly as your asthma action plan says, with a spacer if you have one.
  • Get away from whatever set it off, like smoke, strong smells, pets or dust.
  • Breathe out slowly through pursed lips and try to stay calm. Panic makes your chest feel even tighter.
  • If you carry an epinephrine pen and the attack came with hives, swelling or trouble swallowing, use it and call 911.
  • Don’t stay alone. If paramedics are coming, unlock the door.
  • Bring your inhalers, spacer, action plan and a list of your medicines.

No inhaler with you? Don’t wait for someone to bring it. Go to the ER or call 911.

Asthma Attack Warning Signs in Adults

A mild attack gets better within minutes of your rescue inhaler and stays better. A severe asthma attack doesn’t, or it’s back an hour later. Here’s what that can look like:

  • Your inhaler barely helps, or the relief fades in under 4 hours
  • You’re short of breath just sitting still, or you have to lean forward to breathe
  • You can only get out a few words between breaths
  • Wheezing gets louder, or your chest goes quiet
  • Chest tightness keeps building
  • Your heart is racing, you’re sweating or you feel panicky
  • The muscles in your neck and between your ribs pull with every breath

That quiet chest is easy to miss. It can sound like the wheezing has stopped when very little air is moving at all. An attack that keeps going even after repeated rescue treatment is called status asthmaticus, and it is always an emergency.

Some people should come in sooner than others. That includes anyone who has been in intensive care for asthma, visited the ER for asthma in the past year, or needed steroid tablets recently. Their attacks can turn severe faster.

Asthma Warning Signs in Children

Kids often can’t tell you how bad it feels, so watch their body instead. Take your child to the ER for asthma if you see:

  • Skin sucking in between the ribs, under the ribs or at the base of the neck
  • Fast breathing, even while resting or asleep
  • Nostrils flaring with each breath
  • The belly pumping in and out, or grunting sounds
  • Too breathless to talk, cry, eat or drink
  • Lips or nail beds turning blue or gray
  • Unusual sleepiness, floppiness or trouble waking
  • Rescue medicine that isn’t working, or is needed more often than every 4 hours

Babies breathe much faster than adults even when they’re well, so a fast rate alone is hard to judge. Watch how hard they’re working to breathe instead. If you’re unsure, bring them in. Our pediatric emergency care team treats children of every age, day or night.

What the ER Does for a Severe Asthma Attack

Treatment starts as soon as you walk in. The goal is simple: open your airways, get your oxygen up and find out what set off the attack.

  1. A quick check of your oxygen level with a finger sensor, plus your heart rate, breathing rate and a peak flow reading if you can manage one.
  2. Breathing treatments with albuterol through a nebulizer or an inhaler with a spacer, often combined with ipratropium. You may need a few rounds.
  3. Steroids by mouth or through an IV to calm the swelling in your airways. They take a few hours to kick in and lower the chance of the attack coming back.
  4. Oxygen if your level is low.
  5. Extra medicine for attacks that don’t respond, such as magnesium through an IV.
  6. Tests when needed, such as blood work or an image of your chest if pneumonia or a collapsed lung is possible.

[DR. KUDRATH QUOTE: 2 to 3 sentences in his own words, for example the most common mistake he sees in patients who waited too long. Delete this line if no quote is supplied.]

Top Care ER provides asthma emergency care with an on site lab and imaging, so all of this happens in one visit. Most people go home the same day with a short course of steroid tablets and a plan to see their own doctor within a few days. If you still need help breathing after treatment, our team arranges a fast transfer to a hospital.

COPD Flare Ups: When to Go to the Hospital

A COPD flare up shares a lot with an asthma attack, but it usually builds over a day or two instead of minutes. Go to the hospital with COPD when:

  • You’re far more breathless than your normal and your usual inhalers aren’t helping
  • Your oxygen reading drops below the target your doctor gave you
  • You feel confused or very drowsy, or wake up with a bad headache
  • Your lips or fingertips turn blue
  • You have chest pain or a racing or uneven heartbeat
  • You have a fever with more mucus that is yellow, green or bloody
  • Your ankles swell in a way that’s new for you

Our COPD emergency care treats a flare much like an asthma attack. You get breathing treatments, steroids, oxygen given at a careful level, and antibiotics if an infection is likely.

How to Lower the Risk of Another Attack

Most asthma emergencies can be prevented with a few steady habits:

  • Take your controller inhaler every day, even when you feel fine
  • Keep a written asthma action plan and know your green, yellow and red zones
  • Carry your rescue inhaler and check that it isn’t empty or expired
  • Get a flu shot every year and stay current on the vaccines your doctor recommends
  • Watch Houston triggers: ragweed pollen tends to peak in the fall and mold stays high in humid weather, so check pollen counts and keep windows closed on bad days
  • See your doctor within a few days of any ER visit so your plan can be adjusted

Conclusion

If your rescue inhaler isn’t working, talking is hard or lips are turning blue, don’t wait it out at home. A severe asthma attack can get worse quickly, and early treatment works best.

Top Care ER in Houston Heights is open 24/7 with board certified emergency physicians, an on site lab and imaging, and care for adults and children. Walk in at 1324 N Shepherd Dr #100, Houston, TX 77008, or call (832) 232-0500. If breathing is very hard, call 911.

Frequently Asked Questions

Urgent care can help with a mild attack that’s already easing. A severe asthma attack needs an ER, where you get constant monitoring, IV medicine, oxygen and a hospital transfer if you need one. If you’re not sure which you need, go to the ER.

A mild attack usually eases within minutes of a rescue inhaler. A severe attack can last hours or even days, and it can come back once the inhaler wears off. If you’re not clearly better 15 to 20 minutes after your rescue inhaler, get emergency care.

A fast heartbeat can come from the attack itself or from albuterol. A racing heart along with worse breathing, chest pain, dizziness or confusion needs the ER right away.

No. If you’re struggling to breathe, call 911 so paramedics can start treatment on the way. For a milder attack that isn’t settling, have someone else drive you.

Dr. Abdulla Kudrath is a board certified emergency physician and the owner and medical director of Top Care Emergency Room in Houston Heights, TX. He has worked in emergency medicine for over a decade and has treated thousands of patients across the Houston area. Dr. Kudrath earned his Bachelor of Science in Biology from the University of Houston-Clear Lake, where he graduated summa cum laude, and then finished medical school at the Texas A&M University College of Medicine. He completed his emergency medicine residency at John Peter Smith Hospital (JPS Health Network) in Fort Worth, Texas. He is certified by the American Board of Emergency Medicine and is committed to giving the Houston Heights community fast, caring emergency treatment 24 hours a day.