Annie McDonnell was in elementary school the first time the wheezing set in. She was battling a bout of bronchitis when she started feeling like her chest was tight and she couldn't fully breathe in or out. It was the early symptoms of an asthma attack.

Though she had been diagnosed with asthma already, she didn't have a fast-acting inhaler yet, just a prescription for pills that help the airways relax and open (bronchodilator).

"I remember lying in bed listening to myself wheeze until the medication finally took effect," she tells InStyle. Luckily, her mom had lived through childhood asthma, so she wasn't overly scared. "But when breathing takes effort, you never take it for granted again," she adds.

Annie had more attacks over the years. She says the intensity varies, but the symptoms are usually the same — tightness in the chest, feeling winded, feeling like you can't take a deep inhale or exhale, wheezing, sometimes coughing.

The worst of it was when she was working in Soho in the months after 9/11. In the aftermath, the air quality was terrible — a key trigger for most asthmatics — and there were times when her fast-acting inhaler would only help her wheezing for two to three hours instead of the usual four to six. She'd have to jump in a hot, steamy shower to help her constricted breathing loosen. "It was the first time I'd ever wondered if I would need to go to a hospital for emergency help," she adds.

Asthma is extremely common in both men and women, but it's tough to know what percentage experience actual asthma attacks, says Robert Sporter, M.D., allergy and immunology specialist at ENT & Allergy Associates in New York City. "About 20 percent of asthmatics have frequent attacks — but certainly not all asthmatics do. I'd say most asthmatics probably have at least one in their life.”

Asthma attacks can vary in severity — some can be managed over the phone while other people end up in the ICU for one, Dr. Sporter adds.

But one thing is clear: If you have asthma, you should talk to your doctor about a plan of action should an attack come on — and you need to know the signs to look out for. Here, everything you need to know about asthma attacks.

What exactly is an asthma attack?

The name in itself sounds terrifying. But in reality, an asthma attack basically means your personal asthma level is really bad.

Severe asthmatics are having an "attack” when the symptoms of asthma are coming on stronger than normal (i.e., full-blown wheezing instead of just trouble breathing) or when their rescue inhaler isn’t alleviating symptoms (at all, or for as long as usual, as Annie saw when her inhaler only helped for half the usual time).

But at the same time, if someone with mild asthma who rarely has to use her inhaler is suddenly using it once or twice a day, docs would consider that an asthma attack, Dr. Sporter adds.

What triggers an asthma attack?

Different people have different asthma triggers. Most commonly, it’s either environmental allergens like dust, pollen, and animal dander or air pollutants, like smog, wildfire smoke, or cigarette smoke, says Vandana A. Patel, M.D., medical director for pulmonary rehabilitation and ICU services at Bon Secours Maryview Medical Center in Portsmouth, Va., and clinical advisor for online pharmacy Cabinet.

With winter approaching, there's another factor to keep in mind. "Extremes in weather can also trigger symptoms — so, either hot or cold air," Dr. Sporter adds. Very cold, dry air can cause airways to become irritated and swollen, which worsens asthma symptoms.

Exercise can also trigger asthma in some people, though this is its own branch of the condition (exercise-induced asthma), she explains.

Dr. Sporter adds that respiratory infections, especially viruses, are a major trigger in many asthmatics.

What are the signs of an asthma attack?

Some of the most common symptoms of an asthma attack are trouble breathing, wheezing, a cough (wet or dry), and shortness of breath — which can either be difficulty getting air in, or trouble pushing air out, or both. Some people feel pain in their chest, too.

But the symptoms can also be as bad as feeling like you can’t catch your breath — all the way through to respiratory arrest, Dr. Patel adds.

Both docs agree, there is no single marker of an asthma attack. It’s more about looking at the overall picture: "When an asthma attack is brewing, patients start to lose control of their asthma,” Dr. Sporter explains.

That means feeling things worse than normal, or at a time when you normally don’t, like exercising or standing still. Also, waking up at night with asthma symptoms is a very significant sign of poor or worsening asthma control, Dr. Sporter adds.

What do I do if I’m having an asthma attack?

How much time you have once you start feeling symptoms before you enter a full-blown attack is different person-to-person — sometimes minutes, sometimes hours, sometimes days, Dr. Patel says.

Calling your doc is always an option. (That can be either your primary care physician or asthma specialist.) They can help you figure out how serious the symptoms are and how to treat it, as well as if something else is actually at play, like anxiety.

Ideally though, as an asthmatic, you and your doctor have already worked out a plan of action in case an attack ever happens. (If not, definitely talk to them about that sooner rather than later.) Typically, it looks something like: Use your rescue inhaler once, then wait 15 minutes and check your symptoms (and peak oxygen flow levels, if you have the meter). If they haven't improved, take another two puffs of your rescue inhaler. Check levels and symptoms again in 15 minutes. If they aren't better, call your doctor.

If your symptoms are severe — like it’s really hard to breathe or speak — head to the hospital, Dr. Sporter advises.

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