4 puffs. 4 breaths each. Wait 4 minutes. Repeat. If breathing has not returned to normal after the second round, call 000 — and keep giving the reliever while you wait.
Asthma first aid, step by step
- Sit the person upright. Stay calm, keep them calm, and do not leave them alone.
- Give 4 separate puffs of a blue or blue-grey reliever. Shake the puffer, give 1 puff into a spacer, have them take 4 breaths from the spacer. Repeat until 4 puffs have been given. Shake, 1 puff, 4 breaths.
- Wait 4 minutes. If there is no improvement, give another 4 puffs the same way.
- If breathing still has not returned to normal, call 000 and say it is an asthma emergency. Keep giving 4 puffs every 4 minutes until the ambulance arrives.
No spacer? Give 1 puff as the person takes one slow deep breath, and have them hold it as long as is comfortable. Repeat for each puff.
Not sure it is asthma? Give the blue reliever anyway. It is unlikely to do harm, and the cost of waiting to be certain is higher.
Call 000 immediately — do not work through the steps first
- The person is not breathing
- The asthma suddenly worsens, or is not improving
- They are having an attack and no reliever is available
- You are unsure whether it is asthma
- They are known to have anaphylaxis
What a severe attack looks like
- Obvious difficulty breathing
- Cannot say a full sentence in one breath
- Skin pulling in between the ribs or at the base of the neck
- The reliever is not lasting as long as it usually does
Life-threatening signs: gasping for air, unable to speak more than one or two words per breath, confusion or exhaustion, blue lips, rapid worsening, collapse, or little relief from the reliever.
A quiet chest is not good news. If the wheeze or cough stops, that can mean too little air is moving to make a sound. It is a warning sign, not a sign of recovery.
Asthma, allergy, and which comes first
If someone with known asthma and a food, insect or medication allergy suddenly has trouble breathing, give the adrenaline device first, then the reliever — even with no skin symptoms at all. Treating anaphylaxis as an asthma attack has cost lives. See how to use an EpiPen.
Other relievers
Most reliever puffers are blue or blue-grey and contain salbutamol, available over the counter. Some people use a Bricanyl Turbuhaler, and some use an anti-inflammatory reliever taken as needed — both have different steps. If the person has a written asthma action plan from their doctor, follow that.
If the person becomes unresponsive and is not breathing normally, start CPR — see the DRSABCD action plan.
This is a summary of what is taught in class, not a substitute for training. Skills like this are assessed practically for a reason — reading about them is not the same as having done them. In a real emergency, call 000.
Learn it properly
Responding to respiratory distress, including asthma, is taught in HLTAID011 first aid including CPR and HLTAID012 childcare first aid. Best First Aid Training runs both at Parramatta, Penrith, Blacktown and Liverpool.
Source: Better Health Channel (Victorian Department of Health), Asthma emergency first aid. A person with a written asthma action plan should follow that plan.
