Signs You Need to go to the ER for a Severe Asthma Attack

B.S. Dietetics, Dietitian, Health Professional
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You're lethargic or more tired than normal

Fatigue can sometimes be the first sign that your asthma isn’t under control. If you are overly tired, get it checked out before it ends up in an ER visit. Should your lethargy be in combination with coughing, wheezing, confusion, or any other symptom, head to the ER.


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You or your child is confused

Any severe change in your mental state during an asthma attack should be taken seriously. If you or your child appears disoriented, confused, or has severe anxiety, it’s time to seek emergency care.


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You have chest pain

If you have chest pain that is not relieved by your asthma medications, you need to head to the ER. You could be dealing with pleurisy, pneumonia, or even cardiac related pain. It is urgent to have ANY chest pain evaluated.


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You have uncontrolled coughing that worsens at night

Not everyone with asthma wheezes. An uncontrolled cough that doesn’t resolve with proper rescue medication might mean you or your child should be evaluated in the ER.


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You can't speak

If you can’t complete a full sentence in one breath even after taking your rescue medication, you should call for help. In the early stages of an attack, a Peak Flow Monitor can help your doctor determine your lung function and make medication changes before you get so bad you need the ER.


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You have a bluish tint

A bluish or gray tint to the lips, face, or fingernails is called cyanosis, and it means you or your child is not getting enough oxygen. This is definitely a sign that you should call an ambulance.


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You can see your ribs

During a severe asthma attack, the skin between the ribs or in the neck may sink in during inhalation. This is called retraction and it requires immediate intervention.


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You've stopped wheezing

Many parents see a reduction in wheezing or gulping air as a good sign, but if breathing is still difficult and the wheeze is gone, it could mean that a child’s airways are too narrow and that air can’t move in or out.


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You're hunched over

During a severe asthma attack, many people will unconsciously change their posture by hunching over in order to make it easier to breathe. This posture change can worsen during an acute attack, and it’s a good clue that an asthma attack is serious.


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You've got a gut feeling

If you’ve lived with your own asthma or parent a child with asthma, you likely know what a “typical” attack feels and looks like. Listen to your instincts: if you feel intuitively that an attack is severe, call an ambulance immediately. Nobody knows your body or your child’s health the way that you do.


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Anytime your rescue medication doesn’t resolve symptoms

Follow your health care provider’s Asthma Action Plan and, if those steps fail to resolve you or your child’s symptoms, head to the ER or dial 911.