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Attack or flare?

In my head I was convinced I don’t have asthma attacks, I have flares – my own words / opinion. I’m now not entirely sure my assumption was correct :-\

Is it only an asthma ‘attack’ if it’s bad enough to land you in hospital or at least needing external medical help?

Does my ‘episode’ today sound like an attack rather than a flare?

I went to my tap dancing lesson this afternoon and used my inhaler before I started – as usual. Within about 10 minutes I felt my chest tightening but Little Miss Stubborn took over and I carried on for about another 5 minutes before actually stopping to take my inhaler. It gave me *some* relief but not as complete as it usually does. I carried on dancing but we were doing mainly technical, not elevated so I thought I’d be ok. After another 10-15 minutes I realised I should really use my inhaler again (VERY rare for me to need it more than once). Once I’d stopped and I was on my way home my coughing actually got worse which is not unusual for my pattern of asthma.

It took another 30-45 minutes for me to feel properly ok and even now, over 3 hours later my lungs / airways feel ever so slightly twitchy.

At no point during this did I feel it wouldn’t resolve eventually with my inhaler.

6 Replies

I saw this on the internet, hope it helps to explain things.

For someone with asthma, the airways in the lungs are a problem. They're always a little swollen or irritated, but during an asthma flare-up (also called an asthma flare, attack, episode, or exacerbation), the problems worsen. Sticky mucus clogs these important tubes. And the muscles around the airways tighten up, further narrowing the airway. This leaves very little room inside for the air to flow through. Think of a straw with walls that are getting thicker and narrower, leaving less and less space inside for air to get through.

A flare-up can cause coughing, chest tightness, wheezing, and trouble breathing. A person having a flare-up also might sweat or feel his or her heart beating faster. If the flare-up is severe, the person may struggle to breathe even while sitting still. He or she may not be able to speak more than few words at a time without pausing for breath.

Because they can be life threatening, all asthma flare-ups demand attention. Someone having an asthma flare-up might need to take rescue medication, visit the doctor, or even go to the hospital. Having a set of instructions called an asthma action plan can help you know which course of action is needed.

Flare-Up Causes

Certain things can bring on symptoms in someone who has asthma. These are known as triggers. It may not always be clear what a person's triggers are, but common triggers include tobacco smoke, cold air, exercise, and infections, such as colds.

A lot of people who have asthma also have allergies. In these people, the allergens — the things that cause the allergic symptoms — can also cause asthma flare-ups. Examples of common allergic triggers include animal dander, dust mites, mold, and cockroaches.

Exposure to a trigger can lead to an asthma flare-up in several ways. It can worsen the swelling in the airways and increase the amount of mucus made there. It can also cause the muscles around the airways to tighten, making the airways even narrower.


If you use a ventolin inhaler then after 2 doses (taken at the same time) you have taken the maximum usable dose, after this you can take it as many times as you like and it will make no difference.

It is possible that you havent inhaled the ventolin efficiently and a third dose might give some more relief but generally you will get less and less benefit after the 2nd dose.


Out of interest, why does my plan say up to 20 doses in an attack if after 2 doses (Is that 4 puffs or 2?) it's not useful?


1 puff is 1 dose. I dont know why it says 20 doses, possibly if you are having a very bad attack you only get a small amount into the bronchi so you need many doses.


I tend to think of attacks if I need to start following the red part of the plan (4 puffs, then one a minute, up to 20*). I suppose really, if I need more after 4 and/or my blue reliever doesn't help.

It is something I also have difficulty categorising and so the best I've found it in the BTS/SIGN guidelines. They talk about severity of exacerbation, rather than flares/attacks as different entities.

It's easiest to find in the 2016 quick reference asthma guidelines, page 18:

*My area doesn't faff about with the 'ambulance after 10 puffs' thing and has 'get help - call 999' as the first thing to do in the red zone.


I’m on a smart inhaler and I don’t know whether it’s my flare up or the ventolin but I find more these days that ventolin isn’t helping me at all. When I’m struggling (I never class it as an attack because they’re never severe enough and don’t always last long) if my fostair doesn’t help then I find steaming my face over boiling water sometimes gives relief. I don’t class my flares as attacks because I can quite often still breathe very shallowly and it eventually goes away 🤷🏻‍♀️


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