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 are 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 also can cause the muscles around the airways to tighten, making the airways even narrower.

Left untreated, a flare-up can last for several hours or even several days. Rescue medications often take care of the symptoms pretty quickly, and most people feel better once the flare-up is over, although it can take several days to completely clear up.

Can You Predict a Flare-Up?

Flare-ups vary a lot from person to person and even from attack to attack. Some flare-ups happen suddenly, when someone has been exposed to a trigger, such as tobacco smoke. But others happen because problems in the airways have been building up over time, especially in people whose asthma is not well controlled.

Flare-ups can and should be treated at their earliest stages, so it's important to recognize early warning signs (things that someone might experience just before a flare-up occurs). These clues are unique to each person and might be the same or different with each asthma flare-up.

Early warning signs include:

• coughing, even if you don't have a cold
• throat clearing
• rapid or irregular breathing
• unusual fatigue
• restless sleep or cough keeping you up at night
• difficulty with exercise

A peak flow meter also can be a useful tool in predicting whether a flare-up is on its way.

Preventing Flare-Ups

You also have the power to prevent flare-ups, at least some of the time. Here's what you can do:

• Always have your inhaler and spacer with you.
• Stay away from triggers that you know may cause flare-ups. Try to avoid being around smokers — and never smoke yourself!
• Take your controller medicine as directed. Don't skip it or take less of it because you're feeling better.
• Work with your parents and doctor to follow an asthma action plan.

Reviewed by: Nicole Green, MD
Date reviewed: October 2009

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