Diagnosis
If your symptoms don't improve with at-home treatment, you will need to see your healthcare professional or get emergency care. Even if symptoms improve with at-home treatment, your healthcare professional may want to see you soon for an exam, depending on the severity of symptoms.
If you go to your clinic or the emergency room for treatment, you will likely get treatments and have tests at the same time. The goal is to improve your breathing, to judge how severe an asthma attack is and to see whether the treatment is working.
Tests to measure how well your lungs are working may include:
- Peak flow meter. This device measures how quickly you can force air out of your lungs. Peak flow readings are usually a percentage of how your lungs work at their best.
- Spirometer. A spirometer measures how much air your lungs can hold and how quickly you can breathe out. This measurement is called forced expiratory volume (FEV-1). Your FEV-1 measurement is compared with the typical FEV-1 for people who don't have asthma. As with your peak flow reading, this comparison is often given as a percentage.
- Pulse oximeter. This small device clipped on the end of a finger measures the amount of oxygen in your blood. This shows how well the lungs are delivering oxygen to the blood.
- Nitric oxide measurement. This exam measures the amount of nitric oxide gas you have in your breath when you exhale. High nitric oxide readings are present when there is swelling or other immune system activity in the lungs. This test would likely not be used in emergency care.
Treatment
The goal of management is to treat an asthma attack at home by following your asthma action plan. At-home treatment may be enough to improve symptoms and make breathing easier.
The instructions in the plan also tell you when to see your healthcare professional or get emergency care.
Yellow zone
The yellow zone of an asthma action plan is having moderate asthma symptoms and a peak flow reading of 50% to 79% of your personal best. If you're in the yellow zone, the plan will tell you how many puffs of your quick-relief medicine to take and how often you can repeat the dose. Young children or people who have difficulty with an inhaler use a device called a nebulizer to inhale the medicine in a mist.
Quick-relief medicines include:
- Albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA, others).
- Levalbuterol (Xopenex, Xopenex HFA).
The yellow zone of the plan also will tell you:
- When to take another dose of the quick-relief medicine.
- When to take a pill called an oral corticosteroid to treat inflammation.
- Whether to call your healthcare professional.
Your healthcare professional may tell you whether to take additional doses or change doses of a medicine. You'll likely get instructions about monitoring your symptoms. You may be instructed to go to the clinic or emergency room.
Red zone
The red zone in an asthma action tells you to get emergency care if:
- You are very short of breath.
- The symptoms get worse.
- You're still in the yellow zone after 24 hours.
- You can't do typical activities.
- You have a peak flow below 50%.
- Your healthcare professional tells you to go.
Emergency treatment
If you go to the emergency room for an asthma attack in progress, you'll likely get a number of treatments to restore regular breathing. Treatments may include:
- Oxygen. Oxygen may be given through a tube attached to the nose if there are signs of too little oxygen in the blood.
- Quick-relief medicines. Inhaled quick-relief medicines, such as albuterol and levalbuterol, are given either with an inhaler or a nebulizer to open airways.
- Ipratropium (Atrovent HFA). Ipratropium is a drug also used to open airways that is inhaled with an inhaler or a nebulizer.
- Corticosteroids. Corticosteroids are given as a pill or shot to treat inflammation.
- Mechanical ventilation. If an asthma attack is life-threatening, a machine may be used to help you breathe and get extra oxygen. This may be done with a breathing mask. But in some cases, a tube is placed down the throat and into the windpipe. This procedure is called intubation.
You will be in the emergency room or in the hospital for observation or treatment until you are breathing regularly for some time.
You'll be given instructions for:
- What dose of long-term asthma medicine you should take daily.
- What dose of quick-relief medicine to take and when to take it.
- When to follow up with the healthcare professional who regularly manages your asthma treatment.
- When to get urgent or emergency care.
Preparing for your appointment
If you are getting emergency care, bring your asthma action plan and medicine with you if possible. If you are seeing your primary healthcare professional for treatment or a follow-up appointment, you can prepare by doing the following:
- Take your asthma action plan with you. If you don't have one, ask to make one.
- Bring your peak flow meter results and all of your medicines.
- Be prepared to discuss your symptoms, and how much your asthma has been bothering you.
- Be prepared to demonstrate using your peak flow meter and inhaler.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. Some good questions to ask your doctor include:
- Do my medicines or treatment plan need to be changed?
- What are the signs that I may be about to have an asthma attack?
- What can I take to prevent an asthma attack when my symptoms get worse, or when I'm exposed to my triggers?
- What steps do I need to take to stop an asthma attack in progress?
- When do I need to go to the emergency room or seek other emergency treatment?
- I'm having more heartburn. What can I do to prevent this?
- Is it time for my flu or COVID-19 shot? Am I due for a pneumonia shot?
- What else can I do to protect my health during cold and flu season?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your healthcare professional will likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- Have you noticed anything that makes your asthma worse?
- What medicines are you taking?
- How often are you using your quick-relief medicine?
- Can you show me how you use your peak flow meter?
- Can you show me how you use your inhaler?
- Are you having any problems with your medicine?
- Can you explain how the asthma action plan works?
- Do you know when to call me or go to the hospital?
- Do you have any questions about your asthma action plan?
- Are you having any problems with your asthma action plan?
- Is there anything you want to be able to do that you can't because of your asthma?