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First aid · Australia

Asthma attack

Sit upright and follow the written asthma action plan. With a blue/grey reliever, give 4 separate puffs through a spacer, taking 4 breaths after each puff. If not improving after 4 minutes, call 000 and continue first aid. Call immediately for severe symptoms.

Medical emergency? Call 000

What to do

  1. Sit upright; check severity

    Sit the person upright and stay with them. Call 000 immediately for severe breathing difficulty, rapid worsening, no available reliever or uncertainty about whether it is asthma.

    Take care. Do not lie the person flat.

    Take care. Do not leave them alone.

    Take care. Do not delay 000 for severe symptoms.

  2. Follow their action plan

    Follow their written action plan and help them use the prescribed reliever. Different relievers have different instructions.

    Avoid: Using someone else's written action plan instead of the person's own plan and call-taker advice.

    Take care. Do not guess a device-specific dose when the person has a written action plan.

  3. Blue/grey reliever: 4 separate puffs

    For a blue/grey reliever puffer with a spacer: shake the puffer, give one puff into the spacer and have them take 4 breaths. Repeat until 4 separate puffs have been given.

  4. Reassess after 4 minutes

    Wait 4 minutes. If breathing is not improving, call 000 and ask for an ambulance. Keep giving 4 separate puffs of blue/grey reliever every 4 minutes while waiting, following the call-taker.

  5. Keep checking breathing

    If they become unresponsive and are not breathing normally, start CPR. Sudden breathing trouble with possible anaphylaxis needs adrenaline first; follow the anaphylaxis plan.

Know when to act

When to get help

  • Severe breathing difficulty, blue lips, exhaustion, inability to speak, sudden worsening or little/no relief from the reliever requires 000.

Children and babies

  • Sit the child upright, stay calm and use their written asthma action plan where available.
  • Give the prescribed reliever through the child’s spacer and mask or mouthpiece as instructed; repeat the 4-breath cycle for each puff.
  • Call 000 immediately for a severe attack, sudden worsening, exhaustion, blue lips or little/no improvement, and follow the call-taker.

Keep checking

  • Watch breathing, colour, speech and response. Even after improvement, arrange a doctor’s review as soon as possible to check the treatment plan.

What you may notice

  • Coughing, wheeze, chest tightness or shortness of breath may be mild at first.
  • A severe attack can include difficulty speaking, gasping, exhaustion, drowsiness or blue lips.
  • Little or no relief from the reliever is an emergency warning.

When help arrives

  • Keep the person upright, calm and supervised while following the asthma action plan and 000 instructions.
  • Arrange medical review after an attack, even if symptoms improve, and update the written plan with the doctor.

Other useful answers

What if there is no spacer?

Follow the person’s action plan or device instructions. If a spacer is unavailable in an emergency, give the reliever as directed while arranging emergency help.

Does everyone use the 4 x 4 fallback?

No. Follow the person’s written asthma action plan and medicine-specific instructions first. The 4-puff, 4-breath, 4-minute fallback is for a blue/grey reliever when no plan is available; other devices have different instructions.

Sources and last update

Content updated: 6 September 2026.

These sources inform the guidance. This independent resource is not a substitute for a first aid course or medical assessment. An editorial update is not independent clinical review. Source organisations have not endorsed this site.

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