Ask the Expert About Asthma Warning Signs

What are the symptoms of an asthma attack, and what should I do if my child has one?

When your child has asthma, you are always on the watch for a possible asthma attack: wheezing, frequent coughing, fast breathing, difficulty breathing and chest tightness. “Those are the classic, telltale signs,” says Kristie Ross, MD, a pediatric pulmonologist at University Hospitals Rainbow Babies & Children’s Hospital, “but many people are not aware of the more subtle signs of an impending asthma attack.”

Here is how to read and act upon your child’s asthma signs.

Early Warning Signs

An asthma attack does not have to take you or your child by surprise. Be on the lookout for these early warning signs in your child:

  • Mild cough, especially at night or with activity
  • Sleep disturbance due to cough
  • Cold symptoms that are worse than normal
  • Feeling tired
  • Being short-tempered or irritable
  • Being nervous or on edge

If your child has these symptoms, and your doctor has taught your child how to use a peak flow meter, you can measure the peak flow to see if airways are narrow or blocked. “If the peak flow value is lower than usual or the child begins to show classic symptoms of asthma, like wheezing or frequent cough, he or she should use a bronchodilator (quick relief or rescue medicine),” says Dr. Ross. “If you do not have a peak flow meter and you notice early signs of asthma, you should try a dose of quick relief or rescue medicine to see if it helps relieve the symptoms. This will help relax the muscles in your child’s airways, which makes breathing easier. Over-the-counter cough medicines should not be used in children with asthma without talking to your doctor.”

Work with your child’s doctor to develop an asthma action plan that identifies early signs of asthma worsening in your child and outlines what to do when your child’s asthma flares up. Share the plan with your child’s school and any caregivers, including grandparents and babysitters.

You can download one from Just search for “asthma action plan”.

Signs of Worsening Asthma

It is important to keep your child’s asthma under control. Talk with your child’s doctor if he or she has any of the signs below, which could indicate worsening asthma:

  • Asthma symptoms are more severe, occur more often, are bothersome at night or cause your child to lose sleep. “If asthma symptoms wake your child from sleep more often than one night a week or he or she is regularly limiting activity level due to asthma symptoms, talk to your child’s doctor,” says Dr. Ross.
  • Your child is missing school because of asthma or cannot do activities as usual.
  • Your child’s peak flow meter is low or varies from day to day.
  • Your child’s asthma medicine does not seem to work as well anymore.
  • Your child needs quick-relief medicine two or more times per week.
  • Your child needs to go to the hospital because of an asthma attack.

A change in medicine or other steps might be in order to help get your child’s asthma back in check.

Emergency Asthma Danger Signs

If your child has any of these symptoms, call 911 right away:

  • Trouble walking or talking
  • Hunching over
  • Lips or fingernails that are blue or gray
  • Breathing very slowly
  • Breathing very quickly or trouble breathing that does not get better with quick relief or rescue medicine
  • Rapid pulse
  • Severe drowsiness or confusion
  • Severe anxiety due to shortness of breath

ross-kristie Kristie Ross, MD
Pediatric Pulmonologist
UH Rainbow Babies & Children’s Hospital
Assistant Professor,
Case Western Reserve University School of Medicine

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