It is difficult to predict when asthma symptoms will worsen and become an asthma emergency (attack or flare-up).
Signs and symptoms of a mild to moderate asthma episode include:
- mild wheezing
- trouble breathing
- persistent coughing
- chest tightness
- feeling restless or very tired
Signs and symptoms of a severe to life-threatening asthma emergency include:
- severe wheezing
- gasping
- rapid breathing
- difficulty talking
- bluish lips or fingernails
- feelings of anxiety or fear
- nasal flaring
- working hard to breathe; skin on neck or chest is sucked in with each breath
- incomplete or no relief following the use of reliever (rescue) inhaler
Responding to a Severe to Life-Threatening Asthma Emergency
If a child/youth’s asthma symptoms persist or worsen after using a reliever (rescue) inhaler, they may be experiencing a severe to life-threatening asthma emergency. When this occurs, the response should align with existing school board/child care centre medical emergency procedures and the child/youth’s Plan of Care or Asthma Management Plan.
Sample Emergency Response Steps
Step 1: Administer Inhaler
- Administer reliever (rescue) medication with spacer (if provided) immediately.
- Position the child/youth comfortably, sitting upright with their arms resting on a table.
- Do not have the student lie down, unless they are also having a severe anaphylactic reaction.
Step 2: Call for Help
Call 911 or Local Emergency Services immediately after administering inhaler.
Step 3: Monitor and Repeat Inhaler if Necessary
- Stay with the child/youth, offering reassurance and monitor their symptoms until help arrives.
- Continue administering reliever (rescue) inhaler every 5–15 minutes, if the student’s symptoms are not improving.
Step 4: Transport to Nearest Hospital
- If necessary, and in accordance with school board/child care policy, transport the child/youth to the nearest hospital, ideally by ambulance.
- Bring any inhalers to the hospital for reference and potential further use.
Step 5: Inform Emergency Contacts
Contact the child’s/youth’s parent(s)/guardian(s) to update them on the situation, noting that the reliever (rescue) inhaler was administered and that emergency services have been called.
Note: If it is unclear whether the student is experiencing an asthma emergency or anaphylaxis, it's safest to administer epinephrine first to ensure the student receives the most effective treatment. Epinephrine is effective for both severe allergic reactions and asthma symptoms.
