Asthma treatment, part one: First aid

So, at this point I’ve provided a big load of theoretical information in the previous posts (I will probably get a master list up tonight, hopefully). You know how asthma works, what it’s symptoms are, and how we classify it. In spite of my inclination toward theoretical and mechanistic knowledge, I’m going to take a break from the wheres and whys and hows and provide a bit of practical first-aid knowledge.

Note that I am not a doctor. Nothing I write here is medical advice, I am relaying currently-recommended guidelines for first aid. I will reference articles written by medical professionals. I strongly recommend that everyone get first aid and CPR qualified if finances allow it so you have a more nuanced how-to than being pointed to articles online can give you.

There are two major classes of situation you might find yourself in when dealing with someone who is having asthma symptoms: when the person does have their inhaler, and when they don’t. If you are not a medical professional, you don’t have the expertise (or the instrumentation) to tell the difference between mild, moderate, severe, potentially life-threatening, and live threatening flareups, so I won’t talk about those differences in this post.

If an inhaler is present, that makes things easier. Saint John Ambulance provides the following steps:

  1. Keep the person calm. I will add here, from experience as a patient: If you want to keep the person having an attack calm, you have to act calm yourself. This means: Try to keep your voice quiet. Do not hover. Keep motions slow and steady. Make sure the person wants to be touched if you want to touch them to reassure them. Try not to let your voice shake. Do not lie: Don’t say “you’ll be just fine!” if you’re not sure of it. Socially savvy people will be able to feel your uncertainty and get more scared. Instead focus on things you know are true, like the fact that help is on the way.
  2. Encourage them to use their inhaler. I will add:  They should know how to use it, but you might have to help them get and maybe use it depending on how bad the attack is. A rescue inhaler is usually (not always) a blue metered-dose inhaler. If the person can’t talk or move much, you might have to look through their things to find it. Ask first. “Do you need your inhaler?” “Do you want me to get it for you?” If the person can answer in words, then ask, “Where is it?” If they can’t answer in words, it’s 20 questions time. Common places for inhalers are purses, coat pockets, sweater pockets, gym bags, back packs, night stands, and bathroom drawers. If they have a spacer device (a tube about 7-10 cm (3-4″) long, with a mouthpiece on one end and a rubber rear end with a hole to put the inhaler mouthpiece in on the other end), get them to use that as spacers are better at delivering medicine. At this point, if you can, ask them if they have an asthma action plan, and if they do, ask what they’re supposed to do in yellow zone if they can answer.
  3. Tell the person having an attack to breathe slowly and deeply. You might have to breathe with them so they have a breathing pace to follow (“Breathe slow and deep” becomes meaningless when you’re having a bad one because your whole world is need air need air need air, I say from experience). Get the person sitting down if possible. If they’re having a bad attack, they might want to stand or even pace. If you can convince them to sit, do so, but don’t fight with them over it.
  4. Have them continue to take their inhaler as instructed by their doctor until their breathing improves or until they’ve taken a total of 10 puffs or followed their yellow zone instructions. If their breathing improves significantly then congratulations! You’re done! If it doesn’t, progress to step 5.
  5. Call emergency services. Tell EMS that you have a person who is having an asthma attack and their inhaler isn’t helping. Tell them how many doses of inhaler the person has had, and some basic things about the person who is having the attack – how old are they? Do you know if they have a history of severe asthma? Are they wheezing or coughing a lot? Are they able to talk at all right now? If yes, do they speak normally or *breathe* do *breathe* they *breathe* talk *breathe* like *breathe* this? If they took medicine other than their inhaler, what did they take? What control meds are they on, if you know? And so on. Tell EMS where you are, how to find you if you’re in a large building (in a house, “We’re in the dining room!” is fine, but “I’m in apartment 437” doesn’t help people who don’t know where on your floor room 437 is. It will save them time if they don’t have to ask the building manager for directions.


If at any point, the person passes out or starts to seem confused or drunk or disoriented, call EMS immediately, and if you know it, start rescue breathing. If you don’t know it, get the operator to talk you through. If the attack is getting worse but you haven’t gotten to 10 doses of inhaler yet, call EMS immediately. If you or they think the attack is severe, call EMS immediately. If you are scared and don’t think you can handle it, call EMS. Always err on the side of calling EMS. They would rather you call unnecessarily than not call in an emergency.

If the person does not have an inhaler, see if someone around has one you can borrow. In some areas, they put inhalers in emergency kits, so check the emergency kit, too. If you can get an inhaler, follow the steps above. If you can’t, try to keep the person calm and help them breathe slowly. If the person is a child or is elderly or has other medical conditions that might make breathing harder, call EMS immediately. Able adults can tolerate asthma attacks much better than kids, elderly people, and those with other disabilities. If air quality in the room is bad (like say if someone burned something in the kitchen), move them to a room with better air. Do not move them somewhere with cold air. It is a myth that cold fresh air helps asthma. In reality, cold air triggers asthma. You could make the attack worse if you get them to sit right in front of the air conditioner or go outside in winter.

Try to help them to stay calm and comfortable until the attack passes or help gets there if you’ve already called for help. If the attack seems severe (they can’t talk in full sentences, or they’re wheezing very loudly or they were wheezing but aren’t anymore but seem more distressed, or if they’re coughing so badly they can’t speak much or if they seem to be working hard to breathe), you or they are getting scared, or it just seems to be getting worse, call EMS. As above, it is always better to err on the side of calling EMS than not.

Finally, something which holds true for all cases: unless you’re in a place with no ambulance service, do not attempt to take the person to the hospital yourself. Do not do this. Call EMS instead. You do not have the medical equipment or the expertise to deal with it if the person passes out on you. You can’t help prevent them from passing out by providing oxygen. You don’t have equipment for emergency airway management or the strong medicine for opening airways that EMS has access to in most areas. Don’t try to meet the ambulance – they might drive past you in the confusion. The person is better off waiting for an ambulance wherever they are. Waiting might feel like you’re doing nothing, but if you’ve called EMS, it’s the best thing you can do.

The previous post in this series is here.
The next post in this series is here.