To whom does this guideline apply? 

This guideline applies to adults and children.

Who is the audience for this guideline?

This guideline is for use by bystanders, first aiders and first aid training providers.

Summary of Recommendations

The Australian and New Zealand Committee on Resuscitation (ANZCOR) makes the following recommendations for the first aid treatment of acute asthma:

1. Follow the person’s Asthma Management Plan [Good Practice Statement].
2. If no Asthma Management Plan in place, start treatment with reliever medications following the Asthma First Aid Plan as soon as practicable [Good Practice Statement].
3. If the person does not improve within 5 minutes, or is having a severe asthma attack, send for an ambulance [Good Practice Statement].

Abbreviations

Asthma is a disorder of the smaller airways of the lungs. People with asthma have sensitive airways which can narrow when exposed to certain triggers, leading to difficulty in breathing. This is known as an acute exacerbation of asthma, or asthma attack.^1-3

Three main factors cause the airways to narrow:²

1. The muscle around the airway tightens (bronchoconstriction).
2. The inside lining of the airways becomes swollen (inflammation).
3. Extra mucus (sticky fluid) may be produced.

In asthma, symptoms are made worse by triggers. Every person’s asthma is different and not all people will have the same triggers. Triggers are more likely to provoke asthma in those with poorly controlled asthma.  Triggers can include:^3-5

• respiratory infection
• irritants (e.g. cigarette, woodfire or bushfire smoke, perfumed or cleaning products)
• inhaled allergens (e.g. dust mites, mould spores, animal dander, grass/tree pollen)
• cold air, exercise, laughing/crying
• non steroidal anti-inflammatory agents (e.g. aspirin, ibuprofen)
• sulfite additives (food preservatives)
• food allergy – while usually accompanied by other symptoms such as rash or vomiting, isolated severe asthma may occur as the only presentation
• food colourings and flavours
• emotional triggers such as stress.

Asthma can be recognised by the following signs and symptoms:^1-4

• a dry, irritating, persistent cough, particularly at night or early morning, with exercise or activity
• chest tightness
• shortness of breath
• wheeze (high pitched whistling sound during breathing).

Many people with asthma have personal Asthma Action Plans which have a series of steps to follow if they are experiencing an asthma attack. If a person has an Asthma Action Plan, follow the plan.^{8, 9} 

If there is no Asthma Action Plan in place or you are unable to locate an action plan then use the Asthma First Aid Plan below (refer to section 3.1).

If a person is experiencing any signs of severe asthma (refer to section 2.1) send for an ambulance immediately and then continue to follow the person’s Asthma Action Plan/Asthma First Aid Plan till the ambulance arrives.

If a severe allergic reaction is suspected, follow First Aid Management of Anaphylaxis (refer to ANZCOR Guideline 9.2.7).

*Many fatal cases of food-induced anaphylaxis occur in those with asthma.¹⁰ In persons with asthma known to be at risk from anaphylaxis where it is uncertain whether the person is suffering from asthma or anaphylaxis, it is appropriate to administer an epinephrine (adrenaline) auto-injector first followed by asthma reliever medication. The harm of not treating anaphylaxis outweighs the risk of unnecessary epinephrine (adrenaline) administration [Good Practice Statement].

If at any time the person becomes unresponsive and is not breathing normally, commence resuscitation following the Basic Life Support Flowchart (refer to ANZCOR Guideline 8).

There are differences in first aid treatment recommendations between Australia and New Zealand.^{1, 11}  Additionally, treatment recommendations for the clinical management of acute asthma by health professionals are different again.  Evidence from scientific literature does not suggest any ideal reliever type, reliever dosage or dosage interval for managing acute asthma in a first aid setting.^{8, 14-18}

In Australia, the National Asthma Council Australia recommends taking 4 puffs every 4 minutes (4 x 4 x 4) whereas in New Zealand, the Asthma and Respiratory Foundation NZ recommend taking 6 puffs every 6 minutes (6 x 6 x 6).^{1, 11}

Both the 2015 and 2021 International Consensus on First Aid Science did not provide any update on dosage or interval between doses for asthma management.^{18, 19} This guideline is not intended to contradict current recommendations of peak asthma bodies in Australia or in New Zealand – the ANZCOR recommended treatment in 3.1 accounts for these regional differences.

ANZCOR Guideline 5 Breathing

ANZCOR Guideline 8 Cardiopulmonary Resuscitation

ANZCOR Guideline 9.2.7 Anaphylaxis – First Aid Management

ANZCOR Guideline 9.2.10 The Use of Oxygen in Emergencies

1. Asthma First Aid: Asthma and Respiratory Foundation of New Zealand; [Available from: https://www.asthmafoundation.org.nz/resources/asthma-first-aid-english.
2. Living with Asthma: Asthma and Respiratory Foundation New Zealand; [Available from: https://www.asthmafoundation.org.nz/your-health/living-with-asthma.
3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention.; 2022.
4. About Asthma: Asthma Australia; [Available from: https://asthma.org.au/about-asthma/.
5. Common asthma triggers: Asthma and Respiratory Foundation New Zealand; [Available from: https://www.asthmafoundation.org.nz/your-health/living-with-asthma/common-asthma-triggers.
6. Australian Asthma Handbook: National Asthma Council Australia; [1.1:[Available from: http://www.asthmahandbook.org.au.
7. First Aid for Asthma: National Asthma Council Australia; [Available from: https://www.nationalasthma.org.au/asthma-first-aid.
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13. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention.; 2021.
14. Griffiths B, Ducharme FM, Griffiths B. Combined inhaled anticholinergics and short‐acting beta2‐agonists for initial treatment of acute asthma in children. Cochrane library. 2013;2013(9):CD000060-CD.
15. Kearns N, Maijers I, Harper J, Beasley R, Weatherall M. Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis. The journal of allergy and clinical immunology in practice (Cambridge, MA). 2020;8(2):605-17.e6.
16. Kirkland SW, Vandenberghe C, Voaklander B, Nikel T, Campbell S, Rowe BH, et al. Combined inhaled beta‐agonist and anticholinergic agents for emergency management in adults with asthma. Cochrane library. 2017;2017(1):CD001284-CD.
17. Long D, Bendall J, Bower A. Out-of-hospital administration of corticosteroids to patients with acute asthma: A case study and literature review. Journal of Emergency Primary Health Care. 2008;6.
18. Singletary EM, Zideman DA, De Buck EDJ, Chang W-T, Jensen JL, Swain JM, et al. Part 9: First Aid: 2015 International Consensus on First Aid Science With Treatment Recommendations. Circulation (New York, NY). 2015;132(16 Suppl 1):S269-e1.
19. Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, et al. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Resuscitation. 2021;169:229-311.