Coping with an acute asthma attack is a frightening experience. To deal with asthma, you and those around you need the knowledge to know when an attack is becoming acute, and the confidence to take prompt action.

Always remember that probably you know your own or your child's asthma better than anyone - you have lived with it so if you become frightened, seek help.

Note: the words acute asthma and severe attack are used interchangeably.

What Happens in an Acute Attack?
In an acute attack, the airways are greatly narrowed by swelling, bronchoconstriction and mucus plugging. It's like running on the spot for a few minutes and breathing through a straw. Your diaphragm and chest walls become exhausted and the ability to adequately ventilate the air sacs in the lungs fall. The result is that not enough oxygen can get into the blood and excess carbon dioxide cannot be removed. Unless this situation is resolved, the asthma sufferer will die.

Who is at Most Risk of Suffering an Acute Attack?
There is evidence to suggest that asthmatics at risk for near-fatal or fatal asthma differ from other asthmatics. Important risk factors include advanced age, greater airway reactivity, prior mechanical ventilation and have been on long-term steroid therapy. Additional risk factors include prior asthma hospitalisations, current use of oral corticosteroids or recent withdrawal from oral corticosteroids, problems with treatment compliances and serious psychiatric or psychosocial problems.

Studies have also suggested that regular use of bronchodilators may be associated with an unfavorable outcome in asthma.

The Stages of an Acute Attack?
In acute asthma, symptoms often start out similar to a usual attack; coughing, wheezing, shortness of breath and recession (drawing in the flesh between the ribs and sternum). In an acute attack, however, the symptoms persist, and become more marked or even change in nature.

The asthmatic often becomes quiet and withdrawn, focusing on the struggle to breathe. She sits hunched over, which enables the muscles of the upper body to help expand the chest and consequently the lungs.

Breathing becomes laboured. The expiration is longer, the wheeze becomes louder, and the inspiration is a short harsh gulp. Recession will become marked.

The wheeze, cough or chest tightness continues after they using reliever medication, or returns very quickly after using it. A peakflow reading of 50% or less of the normal reading indicates an acute attack. The asthmatic may not be able to use the peak flow and there is no point forcing them to try - using a peak flow under these circumstances can often make asthma worse.

As the situation worsens, their airways become more clogged and the movement of air lessens. At this point, often the wheezing ceases. This "silent chest" type asthma without any improvement in breathing is not a good sign. It indicates that the airways are extremely narrow and very little air is moving in and out. The asthmatic needs immediate medical attention - an ambulance must be called. Unfortunately, many people interpret the wheeze and gulp disappearing as a sign that asthma is improving, and this has resulted in avoidable deaths.

The asthmatic is unable to speak comfortably, no more than two or three words at a time. As less and less oxygen gets into the bloodstream, the lips will turn blue (cyanosis) and eventually the asthmatic will pass out.