What should I do if my asthma gets worse or I have frequent attacks? 

Recognising that your asthma is becoming less stable is the most important step in preventing a life-threatening event. In the UK, asthma management is designed to keep you symptom free, so any increase in coughing, wheezing, or breathlessness is a clinical sign that your current treatment plan needs review. Whether your symptoms have developed gradually over several weeks or you are experiencing sudden, frequent attacks, taking proactive steps can help you regain control. This article outlines how to identify declining asthma control, the immediate actions you should take using your personalised action plan, and the clinical indicators for seeking emergency medical support. 

What We’ll Discuss in This Article 

• Identifying the early warning signs of worsening asthma control. 

• Immediate steps to take using your personalised asthma action plan. 

• When to book an urgent review with your GP or asthma nurse. 

• Common reasons why asthma control may decline, including triggers and technique. 

• The difference between a mild flare up and a medical emergency. 

• Clinical strategies for stepping up treatment to regain lung stability. 

What actions are recommended if asthma symptoms increase? 

If you notice your asthma symptoms are increasing, your first action should be to consult your written personalised asthma action plan. This document, provided by your UK healthcare team, contains specific instructions on what to do when your symptoms move from the green (well) zone to the amber (getting worse) zone. Usually, this involves increasing the frequency of your preventer inhaler or starting a temporary course of oral steroids as prescribed by a clinician. 

It is vital not to ignore minor symptoms. If you are using your reliever inhaler (usually blue) three or more times a week, waking up at night because of your asthma, or finding that your symptoms are interfering with your daily activities, your asthma is considered poorly controlled. In these instances, you must book an appointment with your GP surgery or asthma nurse as soon as possible to prevent a more serious attack. 

• Consult your personalised asthma action plan for immediate dosage instructions. 

• Track your symptoms and peak flow readings to provide clear data to your doctor. 

• Do not wait for a scheduled review if you are needing your reliever inhaler frequently. 

• Ensure you are using your inhaler with a spacer if one has been prescribed. 

Identifying poor asthma control 

Clinical guidance in the UK uses the 3 Questions test to help patients identify when their asthma is worsening. If you answer yes to any of the following in the last month, your control is declining: have you had daytime symptoms more than twice a week, has your asthma interfered with your daily life, or have you been woken at night by your symptoms? Nighttime waking is a particularly significant red flag that requires urgent clinical attention. 

Another objective way to monitor your control is through peak flow testing. If your peak flow readings are consistently falling below 80% of your personal best, it indicates that your airways are becoming inflamed and narrowed. Monitoring these trends allows you to take action before you experience a full blown attack. 

• Symptom Frequency: Needing your reliever inhaler more than twice a week. 

• Nocturnal Symptoms: Any asthma related waking during the night. 

• Activity Limitation: Being unable to exercise or perform daily tasks due to breathing. 

• Peak Flow Drops: Readings that are significantly lower than your usual best. 

Common causes of frequent attacks 

Frequent attacks often occur when the underlying inflammation in the airways is not being properly managed by preventer medication. This can happen if the preventer is not taken consistently every day, or if the inhaler technique is incorrect, preventing the medicine from reaching the lungs. Even if you feel well, skipping your preventer allows inflammation to build up quietly, making you more vulnerable to triggers. 

Environmental factors also play a major role. A change in the weather, high pollution levels, or increased exposure to allergens like dust mites or pet dander can strain a sensitive respiratory system. Additionally, recent viral infections like a common cold can leave the airways in a hyper reactive state for several weeks, leading to a period of increased symptoms and frequent flare ups. 

• Medication Consistency: Skipping daily preventer doses increases airway sensitivity. 

• Inhaler Technique: Incorrect use means the lungs do not receive the full dose. 

• Viral Triggers: Colds and flu are the leading cause of asthma hospitalisations. 

• Hidden Allergens: New or increased exposure to triggers in the home or workplace. 

Immediate actions during a flare up 

During a flare up, it is important to stay calm and follow the emergency steps outlined in your action plan. Sit upright and take slow, steady breaths. Use your reliever inhaler as directed (usually one puff every 30 to 60 seconds, up to 10 puffs). If you have a spacer, use it, as this helps the medication bypass the back of the throat and go directly into the inflamed airways. 

If your symptoms do not improve after using your reliever, or if they return quickly, you must seek medical help immediately. You should also check your peak flow; if it is less than 50% of your best, this is classified as an acute severe attack and requires emergency intervention. Never wait to see if things improve on their own if you are struggling to breathe. 

• Posture: Sitting upright helps the lungs expand more easily than lying down. 

• Reliever Use: Follow the 1 puff per minute rule until help arrives or symptoms ease. 

• Spacer Utility: Essential for ensuring the reliever reaches the lower airways. 

Differentiating between a flare up and an emergency 

Knowing when to call 999 is a life saving skill. While a mild flare up can often be managed at home by following your action plan and seeing your GP, an asthma attack is a medical emergency. If your reliever inhaler is not providing relief for at least four hours, or if you are too breathless to speak in full sentences, you need emergency care. 

Other emergency signs include your fingernails or lips turning a blueish tint, a feeling of extreme exhaustion, or your peak flow being very low. In children, look for indrawing of the skin around the ribs or neck when they breathe. If you are in any doubt about the severity of an attack, it is always safer to call 999 and seek professional help. 

Feature	Worsening Control (Amber)	Emergency Attack (Red)
Reliever Need	Every few hours	No relief or only short term relief
Speech	Can speak in sentences	Unable to finish a sentence
Peak Flow	50% to 80% of best	Below 50% of best
Next Step	Urgent GP appointment	Call 999 immediately

Conclusion 

If your asthma is getting worse or you are having frequent attacks, it is a clear signal from your body that your current management needs to change. By following your personalised asthma action plan, identifying early warning signs like nighttime waking, and seeking urgent clinical advice, you can prevent a minor flare up from becoming a serious emergency. Regular reviews and consistent medication use remain the most effective ways to keep your asthma stable and your life uninterrupted. 

If you experience severe, sudden, or worsening symptoms, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Stefan Petrov, a UK-trained physician with an MBBS and postgraduate certifications including BLS, ACLS, and PLAB 1 & 2. Dr. Petrov has extensive clinical experience across general medicine, surgery, and emergency care in UK hospital settings, including intensive care units. His background in acute medicine provides him with a deep understanding of the physiological signs of respiratory distress and the critical steps required for asthma stabilisation. He is dedicated to providing accurate, safe, and patient focused health guidance.