Watching someone struggle to breathe during an asthma attack is frightening. The instinct to help is strong, but without knowing what to do, bystanders can feel completely helpless or, in some cases, accidentally make things worse. This guide is for the people standing beside someone in that moment: a parent, a friend, a coworker, a stranger.
Knowing a few clear steps in advance can make a real difference in how an attack unfolds.
Recognize What's Happening
According to the American Red Cross, during an asthma attack, airway inflammation and narrowing make breathing difficult. The trigger causes airway swelling, which can further narrow the airways and block them with mucus, making it harder for air to move out of and into the lungs.
Symptoms to watch for include:
- Wheezing or a whistling sound when breathing
- Persistent coughing
- Chest tightness
- Shortness of breath or difficulty speaking in full sentences
Some attacks are mild and resolve with rescue medication. Others escalate quickly. Healthline advises calling 911 if the person’s rescue inhaler isn’t making symptoms better, they can’t say more than a few words without losing their breath, their chest muscles are visibly straining to breathe, they appear tired or feel faint, or their face or lips begin to turn blue. Do not wait to see whether things improve on their own.
What to Do
Stay calm and keep them sitting upright
Your steadiness matters. As University of Utah Health explains, anxiety compounds the problem during an asthma attack, making it even more difficult to breathe. The best thing a bystander can do, beyond helping with medication, is whatever is possible to help the person stay calm: speak reassuringly, turn on music, keep the environment quiet while waiting for help.
Position matters too. Research cited by Optum Perks confirms that sitting upright helps keep the airways as open as possible, and that lying down can make symptoms worse.
Remove the trigger
If you know what triggered the attack, get away from it. Common triggers include smoke, pollen, pet dander, cold air, and strong fragrances. Move the person to a cleaner environment if possible.
Help them use their rescue inhaler
Most people with asthma carry a rescue inhaler containing albuterol. If they have one and are having difficulty using it themselves, help them access it. Follow any instructions on their asthma action plan if they have one. HSI notes that you should call 911 if the person doesn’t have their inhaler, doesn’t improve after using it, has difficulty speaking, or becomes unresponsive.
Call 911 for severe attacks
If a person cannot get out more than a one-word answer, that is a sign of a severe attack. In that situation, call 911 before spending time looking for an inhaler, because a couple of puffs is unlikely to be enough.
What Not to Do
Knowing what to avoid is just as important as knowing what to do.
- Do not let them lie down. Lying flat restricts airflow and can worsen symptoms.
- Do not give them someone else’s inhaler. Inhalers contain different medications specific to a person’s prescription, and using the wrong one can be harmful.
- Do not leave them alone. Attacks can escalate rapidly, and the person needs someone present in case emergency help is needed.
- Do not assume silence means improvement. As CPR Certified notes, drowsiness can occur even as asthma worsens. If wheezing stops but breathing remains difficult, the attack may still be getting worse.
- Do not wait too long to call 911. If there is any doubt about severity, call. It is always better to have emergency services on the way than to wait and see.
Adults vs. Children: What to Know
The first aid steps above apply to both adults and children, but there are a few differences worth understanding.
Children have smaller airways, meaning even minor airway inflammation can lead to significant symptoms. Their attacks are often triggered by allergens, viral infections, or physical activity. Some children find their symptoms ease or nearly disappear during puberty, though they can return in adulthood.
In adults, asthma attacks can sometimes be trickier to recognize and may be mistaken for other conditions. Adult asthma tends to require more consistent daily management, and severe attacks in adults carry higher risk.
For children using an inhaler during an attack, a spacer device increases how effectively medication reaches the lungs. If one is available, use it. If you are caring for a child with asthma, make sure every caregiver, teacher, and babysitter has a copy of the child’s asthma action plan and knows where the rescue inhaler is kept.
After the Attack
Once the attack has resolved, the person should follow up with their doctor. Even a successfully managed attack is a signal that asthma may not be fully controlled, and a medication adjustment may be needed. If the person does not already have a written asthma action plan, that conversation is worth having at the next appointment.
If the attack required emergency care, a follow-up visit should happen within a few days of discharge.
Note that some severe allergic reactions can trigger asthma-like symptoms. If the person has a known allergy and shows signs of anaphylaxis alongside breathing difficulty, epinephrine takes priority over the rescue inhaler. Follow their anaphylaxis action plan if one exists.