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Acute exacerbation of asthma

Advice for professionals

What is an acute exacerbation of asthma?

A worsening of your child’s asthma caused by exposure to one of their triggers. These vary between children but the most common ones are coughs and colds, cold weather, cigarette smoke, pet fur or feathers and pollen.

If your child’s asthma suddenly gets worse (asthma attack), they will need urgent treatment. Signs of an asthma attack include:
  • Being very wheezy
  • Coughing
  • Having a tight chest
  • Finding it hard to breathe
  • Being too breathless to talk or walk
  • Sometimes there is no obvious cause for your child’s asthma attack. The most common triggers are viral infections (coughs, colds, and chest infections), emotional anxiety, and exposure to airway irritants such as cigarette smoke.

What should I do if my child is having an asthma attack?

1. Sit your child upright

2. Keep them calm and reassure them

3. Refer to your child’s action plan and follow the instructions.

A child asthma action plan will help you and your child to manage their asthma. If your child does not have one yet you can download a child asthma plan for free. 

Asthma Action Plan

Keep this plan with you and take it every time you see the doctor or nurse at your GP surgery (or Hospital). This plan is for patients with asthma – your GP/doctor (or nurse) will fill it in and explain the different medicines to control your asthma. It will also show you how to recognise when the asthma or wheeze is getting worse and what to do about it. By taking steps early – acute attacks can usually be prevented.
 

 

When should you worry?

If your child's:

  • Reliever inhaler is not helping their symptoms
  • If they do not have their reliever inhaler or if you’re worried at any time
  • Too breathless to talk/eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Is pale, blue, mottled or feels unusually cold to touch
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every four hours
  • Breathing that stops or pauses
  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Difficult to wake up, very sleepy or confused
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the glass test)

Ring 999 for immediate help

consider using ‘What 3 words’ to best describe location to ambulance service

Get your child’s inhaler and follow your action plan.

Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives

Keep child in upright position and reassure them

If your child is:

  • Wheezing and breathless and blue (salbutamol) reliever inhaler is not lasting four hours
  • Having a cough or wheeze/tight chest during the day and night
  • Too breathless to run/play/take part in normal activities
  • Needing to use their reliever inhaler three or more times a week 
  • Waking up at night coughing or wheezing 
  • Needing time off school or nursery because of their asthma. 

Immediately contact your GP and make an appointment for your child to be seen that day face-to-face

Give up to six puffs of your reliever inhaler every four hours.  If this is not working, the symptoms return within four hours, or you are worried about your child, arrange for urgent review by a health professional. 

If your child is not improving after 24 hours arrange for a same-day review by a health professional. 

If you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, then consider taking them to your nearest Emergency Department.

 

If none of the above features are present.

  • If your child has a mild cough and wheeze but can continue their normal day-to-day activities
  • Watch them closely for any change and look out for any red or amber symptoms
  • Continue to follow your child’s Asthma action plan while seeking advice.

If your child has other symptoms associated with their asthma attack, you might want to look at our information on sore throat, cough, earache, diarrhoea and vomiting or our other pathways.

Self care

Give two puffs of your reliever inhaler up to every four hours as needed until symptoms improve. 

If you are still worried, please see your local pharmacist or call NHS 111 - call 111.

Children and young people who are unwell and have a high temperature should stay at home. They can go back to school, college or childcare when they no longer have a high temperature, and they are well enough to attend.

This guidance was last reviewed 27/06/2025.

Make sure your child takes their medicines

Your child will usually have a preventer inhaler and a reliever inhaler. Make sure:

•    they take their preventer inhaler every day as prescribed.  
•    your child always has their reliever inhaler with them.  
•    your child uses a spacer if their inhaler is a pMDI (pressurised metered dose inhaler).

Find out more about your child’s asthma medicines. If your child has been diagnosed with severe asthma, they might have a slightly different treatment. Find out more about caring for a child with severe asthma.

 

Get your child’s asthma under control

Children with poorly controlled asthma are much more likely to have an asthma attack. Make sure your child follows their action plan.

Signs of poorly controlled asthma:

●       Needing additional doses of inhaler 3 or more times a week

●       Wheezy after exercise

●       Persistent night-time cough

If your child has symptoms of poorly controlled asthma they should be reviewed. Make an appointment with their GP or asthma nurse.

It is important to have a yearly asthma review with your asthma nurse or GP. Everyone with asthma should have an action plan.

To watch a video on encouraging children to use their inhalers effectively please click here.

Check your child’s inhaler technique

Your child’s GP or nurse will check your child’s inhaler technique at their yearly asthma review. But you can also make sure their inhaler technique is correct day-to-day. Our inhaler technique videos can help you.

Your child’s asthma will not be controlled if their medicines are not getting into their lungs.

See your practice nurse or doctor if you are not sure whether your child is using their inhaler properly.

Avoid triggers where possible:

It can be helpful to monitor your child’s asthma symptoms over time to work out what their triggers might be, or if their asthma is getting worse.

Although it is extremely difficult to avoid your child getting a viral infection or experiencing changes in the weather, you can reduce exposure to common irritants such as cigarette smoke. Even where adults smoke away from their children, smoke on their clothes and hair is likely to make their child’s asthma worse. 

If needed visit the your local stop smoking site.

Your child will be eligible for the influenza (Flu) immunisation every autumn.

Not only can flu trigger an asthma attack in your child, your child is more likely to experience severe influenza if they have asthma. Protect them by having them vaccinated every year. 

 

  • Ensure your child always has access to their reliever (blue) inhaler and spacer
  • Start reliever treatment early at the start of a runny nose - 2 puffs 4 hourly
  • Remember to leave a spare reliever inhaler (with/without spacer) at school for your child and ensure that it is kept in date
  • Remember to take inhaler with you or your child on any trips away from home
  • Always use the correct inhaler device as prescribed for you or your child
  • Remember a spacer is the best way to deliver reliever treatment in an emergency
  • Remember to keep any follow up appointments and attend their annual asthma review at their general practice
  • If your child has been discharged from hospital following an exacerbation, you should arrange for them to be seen in the next 48 hours by the GP/Practice nurse
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