Acute asthma exacerbation in adults

An acute asthma exacerbation in adults presents as an acute or subacute episode of progressive worsening of asthma symptoms, such as shortness of breath, wheezing, cough, and chest tightness.

Oxygen saturation, respiratory rate, subjective assessment of respiratory distress, accessory muscle use, and auscultation of the lung fields are key factors to assess during physical exam.

An increase in airway obstruction that can be quantified objectively by peak flow measurement or forced expiratory volume in 1 second (FEV₁) is typical in an acute exacerbation.

If anaphylaxis as well as asthma is suspected, give epinephrine (adrenaline) first, before starting asthma treatment.

Inhaled short-acting beta-2 agonist (SABA) therapy should be started immediately, if clinically indicated. In more moderate to severe exacerbations, ipratropium should be added and a short course of systemic corticosteroids may also be required. Supplemental oxygen is given in severe exacerbations. Additional therapies should be considered for patients who do not respond adequately to bronchodilators.

Severe and life-threatening exacerbations require urgent transfer to an acute care setting.

Complications include pneumonia, pneumothorax, pneumomediastinum, and respiratory failure.

An asthma exacerbation is characterized by a progressive worsening of symptoms of asthma, including shortness of breath, wheezing, cough, and chest tightness, and a progressive decrease in lung function as measured by peak expiratory flow and FEV₁ from baseline.[1]Global Initiative for Asthma. Global strategy for asthma management and prevention. May 2026 [internet publication]. https://ginasthma.org/wp-content/uploads/2026/05/GINA-2026-Strategy-Report-WMS.pdf ​ An exacerbation of asthma represents a change from the patient's usual status that is sufficient to require a change in treatment.[1]Global Initiative for Asthma. Global strategy for asthma management and prevention. May 2026 [internet publication]. https://ginasthma.org/wp-content/uploads/2026/05/GINA-2026-Strategy-Report-WMS.pdf ​ Exacerbations may occur in patients with a pre-existing diagnosis of asthma or, occasionally, as the first presentation of asthma.​[1]Global Initiative for Asthma. Global strategy for asthma management and prevention. May 2026 [internet publication]. https://ginasthma.org/wp-content/uploads/2026/05/GINA-2026-Strategy-Report-WMS.pdf

This topic covers the management of adults. For children up to 11 years of age, see Acute asthma exacerbation in children. Children 12 years and older are generally treated the same as adults. However, consult your local pediatric guidance, as there may be some differences in the treatment approach, and weight-based dosing may be recommended in some adolescents.