Springdale Mason Pediatrics

Asthma Attack


  • Your child is having an asthma attack
  • Your child has been diagnosed in the past with asthma

Call or Return If

  • Trouble breathing occurs
  • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
  • Wheezing lasts over 24 hours
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic


  • Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
  • Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound.
  • You can hear it best when your child is breathing out.

Asthma Attack Scale

  • Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. No retractions (tugging in between the ribs with each breath). Wheezes not heard. (GREEN Zone: Peak Flow Rate 80-100% of normal rate)
  • Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Mild retractions. Wheezing can be heard. (YELLOW Zone: Peak Flow Rate 50-80% of normal rate)
  • Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Severe retractions. Wheezing may be loud. (RED Zone: Peak Flow Rate less than 50% of normal rate)

Causes (Triggers) of Asthma Attacks

  • Infections that affect breathing (like colds or the flu)
  • Pollens
  • Animals (like cats)
  • Tobacco smoke
  • Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
  • Asthma attacks caused by food allergy can be life-threatening

After Care Advice

  • Over 10% of children have asthma.
  • Your child's asthma can flare up at any time.
  • When you are away from your home, always take your child's medicines with you.
  • The sooner you start treatment, the faster your child will feel better.
  • Here is some care advice that should help.
Asthma Quick-Relief Medicine:
  • Your child's quick-relief (rescue) medicine is albuterol or xopenex.
  • Start it at the first sign of wheezing, shortness of breath or hard coughing.
  • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
  • Repeat it every 4 hours if your child is having any asthma symptoms.
  • Never give it more often than 4 hours without talking with your child's doctor.
  • Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
  • Use the medicine until your child has not wheezed or coughed for 48 hours.
  • Spacer: Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
Asthma Controller Medicine:
  • Long-term controller medicines help prevent asthma attacks. Most are inhaled steroids. They are given daily.
  • Controller medicines keep the airway from getting inflamed and irritated.
  • If your child is on one, keep giving it during asthma attacks.
Cough Treatment:
  • The best "cough medicine" for a child with asthma is usually their asthma medicine.
  • Even if coughing is the only symptom, try the albuterol neb or inhaler.
  • If mild coughing doesn't improve, it may just be a normal part of a cold. Treat it like coughs in children without asthma.
  • Use honey 2 to 5 ml for children over 1 year old. Use cough drops for children over 6 years old.
  • Caution: Don't use cough suppressants such as DM in children with asthma.
Nose Allergies (Hay Fever):
  • For signs of nasal allergies, it's important to take your allergy medicine.
  • Reason: Poor control of pollen or other allergies makes asthma worse.
  • Try to get your child to drink lots of fluids.
  • Goal: Keep your child well hydrated.
  • Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.
  • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
Avoid Tobacco Smoke:
  • Tobacco smoke makes asthma much worse.
  • Don't let anyone smoke around your child.
Avoid Triggers:
  • Shower to remove pollens or other allergens from the body and hair.
  • Avoid known causes of asthma attacks (such as smoke or cats).
  • Do not take part in sports during a bad attack.
What to Expect:
  • If treatment is started early, most asthma attacks are quickly brought under control.
  • All wheezing should be gone by 5 days.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2021 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
Article 2517