Asthma Attack First Aid: What to Do for Kids and Adults
The sitting position that eases breathing, how to help with a reliever inhaler and spacer, and the signs of a severe attack that mean call 911.
To help someone having an asthma attack: (1) sit them upright and slightly forward — never lie them down; (2) keep them calm and encourage slow breaths; (3) help them use their own prescribed blue reliever inhaler, with a spacer if available, following the dosing on their asthma action plan or the inhaler’s instructions; (4) if the reliever isn’t helping, they have no inhaler, or you see any severe sign (blue lips, too breathless to speak, silent chest, drowsiness), call 911 and keep helping with the reliever until paramedics arrive.
An asthma attack happens when the airways in the lungs tighten (bronchospasm), swell, and fill with mucus, making it hard to breathe — the narrowing bites hardest on breathing out, so air gets in but struggles to get back out. For someone in the middle of one, it can feel like breathing through a narrowing straw. Most attacks can be managed with the person’s reliever inhaler — but some become life-threatening, and bystanders who know what to do make all the difference.
This guide covers how to help both children and adults during an asthma attack, the position that eases breathing, how to assist with an inhaler and spacer, and the warning signs that mean you must call 911.
Recognizing an Asthma Attack
During an asthma attack, a person may have:
- Wheezing — a whistling sound, usually when breathing out
- Coughing, often persistent
- Shortness of breath and a feeling of tightness in the chest
- Difficulty speaking in full sentences
- Rapid breathing and a fast heartbeat
- Anxiety or panic — which makes breathing harder still
In children, also watch for the skin sucking in around the ribs and neck, a tummy that moves more than usual with breathing, and the child becoming quiet, still, or floppy — a worrying sign of tiredness.
Step-by-Step: How to Help During an Asthma Attack
1Sit them upright — do not let them lie down
Help the person sit up straight, leaning slightly forward. Resting their arms on a table or the back of a chair can help. Lying flat makes breathing harder. An upright, slightly forward position eases breathing and lets the breathing muscles work better.
2Stay calm and keep them calm
Panic tightens the chest and speeds up breathing, making an attack worse. Speak in a calm, reassuring voice. Encourage slow, steady breaths. Your composure helps them regain control.
3Help them use their own reliever (blue) inhaler — with a spacer
Find their own prescribed blue reliever inhaler (the rescue medication, not the preventer). Help them use it, and use a spacer device if one is available — it delivers the medication far more effectively, especially for children. For the number of puffs and how often to repeat, follow their personal asthma action plan or the instructions that come with the inhaler. First aid guidance is to assist with the person’s own reliever for known asthma — not to give someone else’s medication speculatively.
Source: ILCOR (FA 7122, weak recommendation) & ERC 2025 First Aid — assist with the person’s own reliever inhaler, using a spacer if available. Exact dosing/number of puffs is set by the device instructions for use, the person’s asthma action plan, and local protocols (e.g. AHA 2024 First Aid), not a single universal figure.
4Reassess after the inhaler
If their breathing improves and they feel better, they should still follow up with their doctor — an attack that needed the reliever is worth reviewing. If there is no improvement, if symptoms are getting worse, or if they have worked through their action plan without relief, call 911.
5Keep helping with the reliever while you wait for the ambulance
If you have called 911, keep helping them use the reliever inhaler as directed by their asthma action plan or the 911 dispatcher until paramedics arrive, unless you are told otherwise. Keep them upright and calm.
6If they become unresponsive and stop breathing — begin CPR
In a severe, untreated attack a person can collapse. If they are unresponsive and not breathing normally, start CPR and continue until help arrives. This is a core skill taught in every Life Safe CPR course.
The Signs of a Life-Threatening Attack
Call 911 without hesitation if you see any of these:
- The reliever inhaler is not working or symptoms keep returning quickly
- The person is too breathless to speak, eat, or sleep
- Blue or grey lips, tongue, or fingertips
- Deep sucking-in of the skin around the ribs and neck (especially in children)
- The person is exhausted, agitated, drowsy, or confused — rising carbon dioxide can make a very sick asthmatic drowsy, so this is not a sign they are settling
- A silent chest — the wheeze disappears because too little air is moving, which signals imminent respiratory arrest, not improvement
- The person has no inhaler available
Source: warning signs per Asthma Canada and ERC 2025 First Aid; the “silent chest = arrest” and drowsy-from-CO₂ points reflect established respiratory-emergency teaching (WorkSafeBC 2024).
Helping a Child With Asthma
Children can deteriorate faster than adults and may not be able to describe what they feel. Stay especially alert to the skin pulling in around the ribs, a child going quiet and still, and any blue colour. Always use a spacer for a child’s reliever inhaler if one is available — it makes a real difference. And do not wait too long: with children, when in doubt, call 911.
Common Asthma Triggers to Know
Recognizing triggers helps prevent attacks. Common ones include respiratory infections (colds and flu), allergens like pollen, dust mites, and pet dander, cold air, exercise, smoke and air pollution, and strong emotions or stress. If you know what set off an attack, remove the person from the trigger where you can — for example, move them away from smoke or out of the cold.
Be Ready Before It Happens
If you live with, care for, teach, or coach someone with asthma — or have a child with asthma yourself — the time to learn these steps is now, not in the middle of an attack. A Life Safe first aid course gives you hands-on practice with positioning, inhaler and spacer technique, and CPR, so you can respond calmly and effectively when breathing becomes a struggle.
Frequently Asked Questions
What should you do during an asthma attack?
Sit the person upright — never let them lie down — and keep them calm. Help them use their own prescribed blue reliever inhaler, with a spacer if one is available, following the dosing on their asthma action plan or the inhaler’s instructions. If there is no improvement, no inhaler, or the attack is severe, call 911 and keep helping with the reliever as directed while you wait.
What are the signs of a severe asthma attack?
The reliever not helping, being too breathless to speak in full sentences, blue or grey lips or fingertips, skin sucking in around the ribs and neck, exhaustion, a silent chest (no wheeze because little air is moving), and agitation or drowsiness. Any of these means call 911 immediately.
How many puffs of a reliever inhaler should you give?
There is no single universal number. The number of puffs and how often to repeat come from the person’s own asthma action plan, the inhaler’s instructions for use, and local protocols. Help the person follow their own plan, use a spacer if available, and if the plan runs out of options or breathing isn’t improving, call 911 and follow the dispatcher’s directions.
Should someone sit or lie down during an asthma attack?
Sit up — never lie down. Lying flat makes breathing harder. The best position is upright and slightly forward, perhaps leaning on a table or chair back, which eases breathing and helps the breathing muscles. Encourage slow, steady breaths.
Can you have an asthma attack without an inhaler?
Yes, and it is frightening. If someone is having an attack and has no inhaler or it is empty, call 911 right away. Keep them sitting upright, calm, and breathing slowly. First aid guidance is to assist with the person’s own prescribed reliever, so calling 911 is the priority when none is available.
Learn to Help When Every Breath Counts
An asthma attack can escalate fast. Life Safe’s hands-on first aid and CPR courses teach you to recognize a severe attack, assist with reliever inhalers and spacers, and respond if someone collapses — skills every parent, teacher, and coach should have.
Find a class near you: Toronto • Downtown Toronto • East York • Hamilton • Welland • Guelph
Sources & medical review
Written and reviewed by Milos Radojcic (Canadian Red Cross / Heart & Stroke / Lifesaving Society First Aid & CPR Instructor, 10+ yrs). Clinical content aligned with ILCOR (First Aid task force, FA 7122) and ERC 2025 First Aid guidance on assisting with a bronchodilator (own reliever inhaler + spacer), the Canadian Red Cross, the Heart & Stroke Foundation of Canada, and Asthma Canada. Reliever dosing follows the person’s asthma action plan, the inhaler’s instructions for use, and local protocols. Last reviewed July 2026.