ASTHMA ATTACK Main Symptoms Don't use this guideline unless your child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician. The classic symptom is a wheeze or whistling (purring) sound on breathing out. See More Appropriate Topic(instead of this one) If No previous asthma diagnosis or use of asthma medicines, see WHEEZING. WHEN TO CALL YOUR DOCTOR FOR ASTHMA ATTACK Call 911 Now (your child may need an ambulance) Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath). Your child passed out or has bluish lips/tongue. Wheezing started suddenly after medicine, an allergic food or bee sting. Call Your Doctor Now (night or day) If Your child looks or acts very sick. Looks like he did when hospitalized before with asthma. Difficulty breathing not resolved 20 minutes after neb or inhaler. Peak flow rate lower than 50% of baseline level (personal best). Peak flow rate 50-80% of baseline level after using neb or inhaler. Wheezing (heard across the room) not resolved 20 minutes after using neb or inhaler. Continuous (nonstop) coughing that keeps from playing or sleeping and not improved after using neb or inhaler. Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours. Fever above 105°F (40.6°C). Severe chest pain. Call Your Doctor Within 24 Hours (between 9am and 4pm) If You think your child needs to be seen. Lots of yellow or green nasal discharge now with a fever. Sinus pressure or pain. Fever present for more than 3 days. Call Your Doctor During Weekday Office Hours If You have other questions or concerns. Missing more than 1 day of school/month for asthma. Asthma limits exercise or sports. Asthma attacks frequently awaken from sleep. Uses more than 1 inhaler/month. Mild wheezing persists for more than 5 days. No asthma check-up in over 1 year. Parent Care at Home If Mild asthma attack and you don't think your child needs to be seen. Back to Top HOME CARE ADVICE FOR ASTHMA ATTACK Asthma Rescue Medicine: Start your child's quick relief medicine (eg albuterol inhaler or nebs) at the first sign of any coughing or shortness of breath (don't wait for wheezing) (Reason: early treatment shortens the asthma attack). The best "cough medicine" for a child with asthma is always the asthma medicine. Follow your child's action plan for asthma attacks. Continue the asthma rescue medicine until your child has not wheezed or coughed for 48 hours. Asthma Controller Medicine: If your child is using a controller medicine (eg inhaled steroids or cromolyn), continue to give it as directed. Hay Fever: For nose allergy symptoms, it's OK to give antihistamines. Fluids: Encourage drinking normal amounts of clear fluids (e.g.,water) (Reason: keeps the lung mucus from becoming sticky). Humidifier: If the air is dry, use a humidifier (reason: to prevent drying of the upper airway). Avoid or Remove Allergens: Give a shower to remove pollens, animal dander, or other allergens from the body and hair. Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows, exercise). Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days. Call Your Doctor If: Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours Wheezing is not completely cleared by 5 days Your child becomes worse or develops any of the "Call Your Doctor" symptoms Back to Top Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information. Pediatric HouseCalls Online. Copyright © 2000-2005 Barton Schmitt, M.D. FAAP Reviewed 8/2005 Revised 8/2005 See Other Topics: Wheezing (other than Asthma) View Index of Topics