[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Asthma in adults: assessing an attack, peak flow, inhaler technique and the action plan # Asthma in adults: assessing an attack, peak flow, inhaler technique and the action plan - Safe practice The nurse judges how severe an asthma attack is, measures peak flow, checks inhaler technique and helps the patient follow a written action plan. Updated Nov 13, 2026 ## Key points - Reassess breathing, SpO2 and lung sounds before and after every reliever dose: improvement or not decides the next step. - Signs of a severe attack: blue lips or face, confusion or drowsiness, a rapid pulse, sweating and severe anxiety; call for help at once. - Peak flow: three blows, record the highest; the personal best is set over 2–3 weeks while asthma is controlled. - Action plan zones: green above 80 % of personal best, red below 50 %, yellow in between. - A spacer makes aerosol inhalers easier to use and helps the medicine reach the lungs. - Reliever (bronchodilator) opens the airways; controller (inhaled corticosteroid) reduces inflammation and the risk of severe attacks. ## What it is Asthma is a chronic airway disease with inflammation, swelling and bronchospasm that come and go; the condition page explains it. In hospital the nurse assesses the attack (breathing rate and effort, ability to speak, SpO2, lung sounds, alertness), gives the prescribed reliever and reassesses before and after it, and escalates quickly when the signs of a severe attack appear. Before discharge the nurse teaches the use of the peak flow meter and the personal best, the zones of the written action plan, correct inhaler and spacer technique, and how to avoid triggers. Asthma cannot be cured, but with good control most people lead a normal, active life. ## What it requires - Assessment of an attack: respiratory rate and effort, accessory muscles, ability to speak, wheeze, SpO2, pulse and level of consciousness. - Peak flow meter and the patient's personal best, if known. - A written, personal action plan agreed with the prescriber. - The patient's own inhalers and spacer, to check technique. - A list of the patient's triggers: dust, smoke, fumes, pollen, animal fur, strong perfumes, colds, weather change, exercise, stress. ## Components - Acute assessment and response, with escalation. - Reliever and controller medicines by inhalation, as prescribed. - Self-monitoring with peak flow and symptoms. - Written action plan with green, yellow and red zones. - Trigger avoidance and teaching. ## How it is applied (and why) - Assess rate, effort, speech, SpO2, lung sounds and alertness on arrival: this sets the baseline to judge treatment. - Sit the patient upright and stay calm and close: anxiety increases breathlessness. - Give the prescribed reliever by the ordered device and reassess before and after: improvement guides the next step. - Escalate at once if lips turn blue, the patient becomes drowsy or confused, or the reliever does not help: these are signs of a severe attack. - Once stable, teach the peak flow meter: stand, deep breath, seal lips, blow hard and fast; three tries, record the highest. - Watch the patient use the inhaler with spacer and correct errors: shake, breathe out, seal, press once, breathe in slowly, hold about 10 seconds. - Teach rinsing the mouth with water and spitting after the inhaler, as the instructions say. - Go through the action plan zones and what to do in each: knowing when to step up treatment can prevent a serious attack. - Review the patient's triggers and how to reduce them at home and at work. ## In nursing practice - Waking at night with asthma, or difficulty with usual activities, places the patient in the yellow zone of the plan. - No improvement after 24 hours in the yellow zone is a red-zone sign. - Tachycardia is a common side effect of short-acting bronchodilators; it is checked after each dose. - Inhaler technique is checked by watching the patient use it and correcting each step. ## Common mistakes - Giving the reliever without reassessing the patient afterwards. - Waiting for the saturation to fall before escalating a patient who cannot speak in sentences or is becoming drowsy. - Recording the average or the last of three peak flow blows instead of the highest. - Discharging the patient without a written action plan or without checking inhaler technique. ## Test yourself Think of the answer, then tap the question to see it. ## How is a peak flow reading taken and recorded? Standing, after a deep breath, the patient seals the lips and blows out hard and fast; this is done three times and the highest value is recorded. ## What do the green, yellow and red zones of an asthma action plan mean? Green: above 80 % of personal best, doing well. Yellow: in between, getting worse, add the reliever. Red: below 50 %, medical alert, seek help. ## Which signs show a severe asthma attack that needs immediate help? Blue lips or face, confusion or drowsiness, a rapid pulse, sweating, severe anxiety and a reliever that does not help. ## What is the difference between a reliever and a controller inhaler? The reliever, a bronchodilator, opens the airways quickly; the controller, an inhaled corticosteroid, reduces airway inflammation and the risk of severe attacks over time. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/asthma-in-adults-assessing-an-attack-peak-flow-inhaler-technique-and-the-action/) ## Elsewhere in DurgiPedia - [Asthma: pathology](https://durgical.com/en/general-pathology/asthma-pathology/) ## Connections ## Related 3 - [Other routes: inhaled, topical, eye, ear, rectal and vaginal](https://durgical.com/en/nursing/other-routes-inhaled-topical-eye-ear-rectal-and-vaginal/) - [Pulse oximetry at the bedside: placement and pitfalls](https://durgical.com/en/nursing/pulse-oximetry-at-the-bedside-placement-and-pitfalls/) - [Oxygen therapy: devices, flows and safety](https://durgical.com/en/nursing/oxygen-therapy-devices-flows-and-safety/) ## Related conditions 1 - [Asthma](https://durgical.com/en/conditions/asthma/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Asthma, fact sheet](https://www.who.int/news-room/fact-sheets/detail/asthma) (World Health Organization (WHO), 2026); [Living with asthma (asthma action plan)](https://www.cdc.gov/asthma/living-with/index.html) (Centers for Disease Control and Prevention (CDC), 2026); [How to use your peak flow meter](https://medlineplus.gov/ency/patientinstructions/000043.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [How to use an inhaler - with spacer](https://medlineplus.gov/ency/patientinstructions/000042.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Nursing Pharmacology, 5.3: Diseases of the Respiratory System](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Pharmacology_(OpenRN)/05%3A_Respiratory/5.03%3A_Diseases_of_the_Respiratory_System) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2020). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. 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