What can someone with an asthma exacerbation do to feel better?

Managing Asthma Exacerbation: Immediate Actions to Feel Better

For immediate relief during an asthma exacerbation, use a short-acting beta-agonist (albuterol) inhaler—2 to 10 puffs via metered-dose inhaler with spacer or 2.5-5 mg via nebulizer—and take oral corticosteroids (prednisone 40-60 mg) early, as this combination reduces the risk of severe exacerbation and hospitalization. 1, 2

Immediate Home Treatment Steps

First-Line Bronchodilator Therapy

• Administer albuterol immediately using either a metered-dose inhaler (MDI) with spacer (4-8 puffs) or nebulizer (2.5-5 mg) 2, 3
• Repeat the albuterol dose every 20 minutes for up to 3 doses during the first hour if symptoms persist 1, 2
• Continue albuterol every 1-4 hours as needed after the initial treatment period 2, 4

Early Corticosteroid Administration

• Take oral prednisone 40-60 mg immediately for moderate to severe symptoms—this is critical as early corticosteroid use reduces hospitalization rates 1, 2, 5
• Oral corticosteroids work by decreasing airway inflammation, which is the underlying problem during an exacerbation, not just the bronchoconstriction 1
• A 5-10 day course is typically sufficient, and tapering is not necessary for courses less than 10 days 2

Supportive Measures

• Remove yourself from any allergens or irritants in the environment that may be contributing to the exacerbation 1
• Sit upright to optimize breathing mechanics
• Stay calm—pursed-lip breathing may help maintain composure, though it doesn't improve lung function 1

When to Seek Emergency Care

Red Flags Requiring Immediate Medical Attention

You need to go to the emergency department or call 911 if you experience any of these warning signs:

• Inability to speak in complete sentences due to breathlessness 2, 3
• Confusion, drowsiness, or altered mental status 3
• Bluish discoloration of lips or fingernails (cyanosis) 3
• Peak flow less than 50% of your personal best (if you monitor peak flow) 1
• Symptoms not improving after 3 doses of albuterol over one hour 1, 2
• Decreased responsiveness to your rescue inhaler or shorter duration of relief 1

High-Risk Patients Requiring Extra Vigilance

Seek medical care earlier if you have any of these risk factors for severe exacerbations:

• Previous severe exacerbation requiring intubation or ICU admission 1
• Two or more hospitalizations or more than 3 emergency department visits in the past year 1
• Using more than 2 canisters of rescue inhaler per month 1
• History of difficulty perceiving how severe your asthma is getting 1

What NOT to Do

Ineffective Home Remedies to Avoid

The following strategies are not recommended as they have no proven benefit and may delay necessary medical care:

• Drinking large volumes of liquids 1
• Breathing warm, moist air 1
• Using over-the-counter antihistamines or cold remedies 1
• Doubling your inhaled corticosteroid dose—this is not effective for acute exacerbations 1

Monitoring Your Response

Track These Parameters

• Monitor your breathing rate and effort—worsening breathlessness despite treatment requires medical evaluation 2, 3
• Check peak expiratory flow if you have a meter—improvement to above 70% of your personal best indicates good response 1
• Assess how long relief lasts from each albuterol dose—decreasing duration of effect is concerning 1

Follow-Up After Stabilization

Preventing Future Exacerbations

Once symptoms improve:

• Continue oral corticosteroids for the full prescribed course (typically 5-10 days) even if you feel better 2
• Follow up with your physician within 1 week to reassess your asthma action plan 2
• Consider stepping up your maintenance therapy if this exacerbation indicates poor control 1
• Review your written asthma action plan with your provider—having a plan reduces exacerbation severity 1

Important Caveat About Combination Rescue Inhalers

Recent evidence shows that combination inhalers containing both a fast-acting beta-agonist and corticosteroid (such as albuterol-budesonide) used as needed reduce severe exacerbations by 26% compared to albuterol alone 6, 7. If you're not already on a maintenance inhaled corticosteroid/long-acting beta-agonist, discuss this option with your physician for future exacerbations 8.