In an asthma attack: sit upright, stay as calm as you can, take one puff of your reliever inhaler every 30–60 seconds up to a maximum of 10 puffs — and if you feel worse at any point or don't feel better after 10 puffs, call 999. That's the core of the recognised UK guidance. Read this article now, calmly, so the steps are familiar if you ever need them — and note that if your plan uses a MART/combination inhaler, your action plan's own instructions take precedence.
Recognising an attack
An attack can build over hours or arrive in minutes. The signs:
- Reliever not helping, or relief not lasting
- Wheezing, coughing or chest tightness that's getting worse
- Too breathless to speak comfortably, eat or sleep
- Breathing faster, feeling like you can't catch your breath
- In severe attacks: struggling to complete sentences, blue-tinged lips or fingers, exhaustion — or a silent chest (too little air moving to wheeze). These mean call 999 immediately, skip everything else
The steps
- Sit up straight — don't lie down. Upright posture keeps airways as open as possible. Loosen tight clothing
- Keep as calm as you can. Panic speeds breathing and worsens the spiral — slow, steady breaths as much as possible
- Take one puff of your reliever (usually blue) every 30 to 60 seconds, up to 10 puffs. Use a spacer if you have one — during attacks it delivers the medicine far better. Slow, deep breath per puff, hold if you can
- Call 999 if: you feel worse at any point while using the inhaler, you don't feel better after 10 puffs, or you're worried at any time. Tell them it's an asthma attack
- While waiting for the ambulance: if it hasn't arrived within 10 minutes and symptoms are no better, repeat step 3 — another round of up to 10 puffs. Stay sitting up, stay with someone if possible, keep your inhaler with you
If you have no reliever inhaler with you: call 999. Don't wait, don't drive yourself, don't "see how it goes".
After the ambulance question is settled — even if you didn't need one
An attack managed at home still isn't over. UK guidance is clear: see your GP or asthma nurse within 48 hours of any attack — ideally the same day. Attacks cluster: the days after one carry elevated risk of another, and an attack is proof your current treatment plan wasn't holding. That review checks your inhaler technique, steps up treatment where needed, and updates your action plan. If you were treated in hospital, you should also be seen within 48 hours of discharge.
Reduce the odds of the next one
- Get a written asthma action plan — a personalised sheet saying exactly what to do as symptoms change. People with plans are significantly less likely to be hospitalised. Ask at your next appointment; Asthma + Lung UK publishes the standard template
- Take the preventer daily — most attacks happen on a background of untreated inflammation (see reliever vs preventer)
- Watch the warning signs — rising reliever use and night waking precede most attacks by days (the full checklist)
- Carry your reliever everywhere. Not in the other coat. Everywhere
If you witness someone else's attack
Help them sit upright, stay calm and speak reassuringly, help them take their own reliever following the steps above (their spacer too, if they have one), and make the 999 call for them if the thresholds are met — a person struggling to breathe shouldn't also be managing a phone call. Don't leave them alone, and don't give them anyone else's medication other than a reliever inhaler in an emergency.
Frequently asked questions
How many puffs of the blue inhaler in an attack?
One puff every 30–60 seconds, up to 10 puffs, through a spacer if available. Worse at any point, or no better after 10 — call 999. Repeat the sequence if the ambulance is longer than 10 minutes.
Should I call 999 or wait it out?
Call if you feel worse at any point, aren't better after 10 puffs, can't complete sentences, or have no reliever with you. Nobody at 999 thinks an asthma call is an overreaction.
Do I need to see a doctor if the attack settled at home?
Yes — within 48 hours. Attack risk is elevated in the following days, and the attack itself is evidence your treatment plan needs adjusting.
Can an asthma attack happen without wheezing?
Yes — and a quiet or silent chest in someone struggling to breathe is a danger sign, not reassurance. Severe attacks can move too little air to wheeze. Treat the breathing difficulty, not the soundtrack.
References
- Asthma + Lung UK. Asthma attacks — what to do. asthmaandlung.org.uk.
- NICE/BTS/SIGN. Asthma: diagnosis, monitoring and chronic asthma management (NG245).
- NHS. Asthma attack. nhs.uk/conditions/asthma/asthma-attack.
- Royal College of Physicians. Why asthma still kills: National Review of Asthma Deaths. 2014.