Breathing Problems: Asthma, a Chronic Lung Condition

Breathing Problems and Asthma: A Real Story, Warning Signs and Life-Saving First Aid

Asthma is more than occasional wheezing. It is a chronic respiratory disease that can suddenly become life-threatening. Understanding its symptoms, triggers and treatment can help people recognize an asthma attack and respond appropriately.

Imagine being a teacher who develops a cold, struggles to breathe and assumes that the symptoms will eventually improve. You return to work because you believe you can manage the situation, only to discover that your breathing difficulties are much more serious than you expected.

This is not a fictional scenario. It is based on the experience of Beth, a primary school teacher who was hospitalized following an acute asthma attack.

Her story illustrates an important lesson: asthma should never be dismissed as a minor inconvenience, even when a person has lived with the condition for years.

In this article, Bangkok First Aid explores the science behind asthma, its causes and symptoms, how to recognize a potentially life-threatening attack, and the first aid actions that can help someone experiencing severe breathing difficulties.

Whether you are a parent, teacher, workplace safety officer, lifeguard or simply someone who wants to be better prepared for a medical emergency, understanding asthma can help you respond with greater confidence.

NOTE: Medical disclaimer: This article provides general educational information. It does not replace professional medical advice, an individualized asthma action plan or emergency medical care.

1. A Real Asthma Story: When Breathing Difficulties Become an Emergency

Beth is a primary school teacher who previously lived in Hong Kong before returning to the United Kingdom. In a personal account published by Asthma + Lung UK on 29 January 2026, she described how a period of illness developed into a serious asthma exacerbation.

Beth initially had a cold and felt unwell enough to take two days off work. Although she continued using her inhalers, her breathing difficulties persisted.

Instead of continuing to prioritize her recovery, she decided to return to work. She explained to the children she taught that her asthma was affecting her. Later, her head teacher and deputy head teacher saw her condition and sent her home.

The situation became more concerning when Beth sought medical advice. After examining her chest, her general practitioner told her that she needed to go to hospital immediately.

Doctors diagnosed an acute asthma attack, and Beth remained in hospital for six days.

Her recovery did not end when she left the hospital. She experienced considerable fatigue and struggled to return to her normal activities and work routine. Support from her colleagues helped her resume her responsibilities gradually.

Reflecting on what happened, Beth shared an important message:

“I always used to say ‘it’s just asthma’ but the reality is that it needs to be taken seriously.”

Source: Beth's personal account, published by Asthma + Lung UK, January 2026.

Beth's experience highlights several important lessons.

First, respiratory infections can trigger worsening asthma symptoms. Second, continuing to experience breathing difficulties despite using prescribed inhalers should not be ignored. Third, a person can underestimate the seriousness of their condition, particularly when they are accustomed to living with asthma.

Finally, severe asthma attacks can have consequences that continue long after the immediate emergency has passed.

Beth's story is a reminder that someone who is struggling to breathe may need medical assessment even if they remain conscious, can communicate or believe they can manage their symptoms themselves.

Read the original patient story: I Really Underestimated How Bad My Asthma Was Until I Was Hospitalised — Asthma + Lung UK.

2. What Is Asthma?

Asthma is a chronic respiratory disease characterized by inflammation of the airways and variable respiratory symptoms, including wheezing, coughing, chest tightness and shortness of breath.

The condition affects the bronchial tubes, which transport air between the windpipe and the lungs.

In a healthy respiratory system, air travels through the airways into tiny air sacs called alveoli. These structures allow oxygen to enter the bloodstream and carbon dioxide to leave the body during exhalation.

In a person with asthma, the airways can become unusually sensitive to certain triggers. Exposure to these triggers can cause the airway muscles to contract, the lining of the airways to swell and mucus production to increase.

Together, these changes reduce the space available for air to move through the respiratory system.

Asthma is a variable condition. A person may experience periods when breathing feels completely normal, followed by episodes of coughing, wheezing or breathlessness.

Some people experience occasional symptoms, while others have persistent asthma that requires more intensive medical management.

Asthma can develop during childhood or adulthood. Although it cannot always be cured, appropriate treatment can often achieve good symptom control and reduce the risk of severe attacks.

According to the Global Initiative for Asthma (GINA), asthma diagnosis and management should be based on clinical assessment, evidence of variable respiratory symptoms and, where possible, objective evidence of variable expiratory airflow limitation.

3. What Happens Inside the Lungs During an Asthma Attack?

To understand why asthma can become dangerous, it helps to examine the physiological changes occurring inside the airways.

Three processes commonly contribute to airflow obstruction.

Airway inflammation

The inner lining of the bronchial tubes becomes inflamed and swollen. Immune cells and inflammatory mediators contribute to increased sensitivity and narrowing of the airways.

In some people, type 2 inflammation involving pathways associated with eosinophils, IgE and other immune signaling molecules plays a significant role. Other asthma patterns involve different mechanisms.

Bronchoconstriction

Smooth muscles surrounding the airways contract, reducing their internal diameter. This process is known as bronchoconstriction.

The narrower the airways become, the greater the resistance to airflow. The person must work harder to move air, particularly during exhalation.

Increased mucus production

The airway lining may produce excess mucus, which can further restrict airflow.

The combination of inflammation, muscle contraction and mucus production can cause significant respiratory distress.

A person may develop rapid breathing, wheezing, chest tightness and difficulty speaking comfortably.

During a severe attack, the lungs may not ventilate adequately. Oxygen levels can fall, and carbon dioxide may accumulate as respiratory function deteriorates.

The person may initially compensate by breathing faster and using additional muscles around the chest and neck. However, maintaining this effort can become exhausting.

One particularly concerning sign is a person who remains severely breathless but develops very little audible wheezing. This can indicate that airflow has become critically reduced rather than that the attack is improving.

A first aider should never rely on the presence or absence of wheezing alone to judge the severity of breathing difficulties.

4. What Causes Asthma?

Asthma does not have one universal cause. It develops through a complex interaction between genetic susceptibility, immune-system characteristics and environmental influences.

Having a family history of asthma or allergies can increase the likelihood of developing the condition, but not everyone with these risk factors will develop asthma.

Common triggers include:

• Allergens: Dust mites, pollen, mould and animal allergens.

• Respiratory infections: Viral infections that inflame the respiratory tract.

• Air pollution: Fine particulate matter, traffic emissions and smoke.

• Tobacco smoke: Both direct smoking and secondhand exposure.

• Workplace irritants: Dust, chemical fumes, cleaning products and other airborne substances.

• Exercise: Physical activity can trigger temporary airway narrowing in some people.

• Weather: Cold air and other environmental changes may aggravate symptoms.

• Strong emotions: Stress, crying and laughter can trigger symptoms in susceptible individuals.

Triggers differ between individuals. Identifying the exposures associated with a person's symptoms can help guide prevention and treatment.

Asthma and secondhand smoke: A real story

Ellie N., whose experience is documented by the US Centers for Disease Control and Prevention (CDC), developed asthma in her mid-30s despite never smoking herself.

She worked as a bartender in an establishment where customers smoked. Her doctor identified secondhand smoke as a trigger for her asthma attacks.

Describing her first attack in 1990, Ellie said:

“I had trouble breathing. It was terrifying!”

After several hospital visits and medical advice, she decided to leave a job she loved rather than continue exposing herself to secondhand smoke.

Ellie's experience demonstrates that respiratory health can be affected by the environment even when a person does not directly engage in the activity causing the exposure.

It also highlights the importance of smoke-free workplaces and effective controls for airborne respiratory irritants.

Source: Ellie N.'s Story — CDC.

Asthma and air pollution in Thailand

Air quality is an important consideration for people with asthma living in Thailand.

Exposure to fine particulate matter, including PM2.5, can irritate the respiratory system and aggravate symptoms in susceptible individuals. Smoke from burning activities, traffic pollution and other airborne irritants may also contribute to respiratory problems.

People with asthma should follow local air-quality information, take their prescribed medication and follow their healthcare professional's advice when pollution levels are high.

Reducing exposure to relevant triggers does not replace appropriate asthma treatment.

5. Recognizing the Symptoms of Asthma

Asthma symptoms vary in frequency and intensity. Some people experience symptoms mainly at night, during exercise or after exposure to allergens. Others experience symptoms throughout the day.

Common symptoms include:

• Wheezing: A whistling sound caused by airflow through narrowed airways, often more noticeable during exhalation.

• Shortness of breath: A sensation of not getting enough air or struggling to breathe normally.

• Chest tightness: A feeling of pressure, constriction or discomfort in the chest.

• Persistent coughing: Coughing that may worsen at night, early in the morning or after exercise.

• Reduced exercise tolerance: Difficulty completing physical activities that were previously manageable.

• Night-time symptoms: Waking because of coughing, wheezing or breathlessness.

A characteristic feature of asthma is variability. Symptoms can improve and worsen over time, depending on airway inflammation, exposure to triggers and treatment.

However, these symptoms are not exclusive to asthma. Other conditions, including pneumonia, heart disease, anaphylaxis and airway obstruction, can produce similar signs.

A first aider should therefore focus on recognizing respiratory distress rather than attempting to make a definitive diagnosis.

NOTE: If you recognize the signs and symptoms of severe respiratory distress, reassure and help them find a comfortable position. If they have medication, assist them in taking it, and call your emergency phone number (1.6.6.9 in Thailand) immediately.

6. When Does Asthma Become a Medical Emergency?

An asthma attack, also called an asthma exacerbation, occurs when symptoms and airflow obstruction become significantly worse than usual.

Some attacks develop gradually, while others progress rapidly. Severe asthma exacerbations can be life-threatening and require urgent medical treatment.

Warning signs include:

• Severe or rapidly worsening breathlessness.

• Difficulty speaking in complete sentences.

• Rapid breathing or obvious effort when breathing.

• Retractions around the ribs or neck, especially in children.

• Blue or grey discoloration of the lips or skin.

• Increasing exhaustion or inability to remain alert.

• Confusion, drowsiness or collapse.

• Very weak breathing or markedly reduced airflow.

A person who is unable to speak normally because of breathlessness requires urgent assessment. Do not wait for the appearance of every warning sign before seeking help.

It is also important to recognize that asthma attacks can affect people who have previously experienced relatively mild symptoms.

Beth's experience illustrates why persistent or worsening breathing difficulties deserve medical attention, even when someone is already using their prescribed inhalers.

In Thailand, call 1669 for emergency medical assistance when severe breathing difficulties occur.

Do not delay an emergency call while searching for medication or waiting to see whether the person improves.

7. First Aid for an Asthma Attack: What Should You Do?

The priorities are to recognize the emergency, support the person's breathing, help them access their prescribed reliever medication and obtain medical assistance when indicated.

Step 1: Check the scene for danger

Assess the surroundings before approaching.

Look for smoke, chemical fumes, fire or other hazards that may have triggered the breathing difficulties.

If a suspected irritant is present, help the person move away from it if this can be done safely. Do not enter a dangerous environment or expose yourself to hazardous substances.

Step 2: Assess the person's condition

Introduce yourself, explain that you want to help and obtain consent when possible.

Ask whether the person has asthma, whether they have their prescribed inhaler and whether they have already taken their medication.

Observe their breathing, ability to speak, skin colour and level of consciousness.

Do not assume that the person is experiencing asthma simply because they are wheezing. Other serious conditions can produce similar symptoms.

Step 3: Help the person adopt a comfortable position

Help the person sit upright or adopt another position that makes breathing easier.

Avoid forcing them to lie flat if this makes breathing more difficult.

Speak calmly, reassure them and discourage unnecessary physical exertion.

Reassurance can help reduce distress, but it does not treat airway obstruction and must never delay emergency assistance.

Step 4: Assist with their prescribed reliever inhaler

Help the person access their prescribed asthma medication.

If they have difficulty using their inhaler, provide assistance within your training and follow their asthma action plan.

A compatible spacer can improve medication delivery from a pressurized metered-dose inhaler and may be particularly useful for children or people who have difficulty coordinating inhalation.

Different inhalers contain different medications and have different instructions. Some people use a short-acting bronchodilator, while others have been prescribed an inhaled corticosteroid-formoterol combination for symptom relief.

Follow the person's prescribed treatment plan and device instructions. Do not invent a dose, substitute someone else's medication or assume that all inhalers are used in the same way.

Step 5: Call emergency services when indicated

Call 1669 in Thailand if the person has severe breathing difficulties, cannot speak normally because of breathlessness, becomes confused or drowsy, collapses, deteriorates rapidly or does not improve adequately after using their prescribed reliever.

Call promptly if a person with significant breathing difficulties does not have their medication available.

Follow the emergency call handler's instructions and provide a precise location and a clear description of the person's condition.

Step 6: Monitor continuously

Stay with the person and observe their breathing and responsiveness.

If their condition improves, continue monitoring them and follow their asthma action plan. Improvement does not necessarily mean the attack has completely resolved.

If the person becomes unresponsive, check whether they are breathing normally.

If they are not breathing normally or are only gasping, call emergency services, obtain an AED if available and begin CPR according to your training and the dispatcher's instructions.

If the person is unresponsive but breathing normally, monitor them closely and provide appropriate positioning according to your training and the circumstances.

Do not give food or drink to someone with severe breathing difficulties or reduced consciousness.

NOTE: Avoid moving a person experiencing respiratory distress unnecessarily. Unless absolutely necessary, avoid moving the person, as movement may exacerbate their condition. Wait for trained medical professionals to assess and transport the individual safely.

8. Understanding Asthma Inhalers

Inhalers deliver medication directly into the respiratory tract. Different types of inhalers contain different medications and serve different purposes.

Understanding the distinction between reliever and controller treatment is important for long-term asthma management.

Reliever medication

Reliever medication helps reduce acute asthma symptoms.

Short-acting beta₂-agonists, such as salbutamol, relax the smooth muscles surrounding the airways and can improve airflow.

Some treatment plans use an inhaled corticosteroid-formoterol combination for symptom relief. Formoterol is a rapidly acting bronchodilator, while the corticosteroid helps control airway inflammation.

The appropriate medication depends on the individual's prescription and treatment plan.

Controller medication

Inhaled corticosteroids (ICS) reduce airway inflammation and are central to preventing asthma exacerbations.

They may be taken regularly or as part of a prescribed combination regimen.

An inhaled corticosteroid used alone is not a substitute for a rapidly acting bronchodilator during an acute attack.

GINA recommends inhaled corticosteroid-containing treatment for adults and adolescents with asthma rather than relying solely on short-acting bronchodilators. Treatment should be individualized by a healthcare professional.

Why inhaler technique matters

Incorrect inhaler technique can prevent medication from reaching the lungs effectively.

Common errors include inhaling too quickly through a pressurized metered-dose inhaler, failing to coordinate inhalation with medication release, or not using a prescribed spacer correctly.

Dry-powder inhalers have different requirements and generally depend on the user generating adequate inspiratory flow through the device.

Patients should receive practical instruction and have their inhaler technique checked regularly.

A first aider should not change the person's medication regimen or select a dose independently.

NOTE: Follow your healthcare provider's instructions and the instructions provided with the inhaler. Keep your inhaler clean and properly maintained. Keep track of how many doses you have used so you know when it's time to refill your prescription.

9. Can Asthma Attacks Be Prevented?

Asthma cannot always be prevented, but effective management can reduce symptoms and the risk of severe attacks.

Follow the prescribed treatment plan

People with asthma should use their prescribed medication as directed and discuss difficulties with adherence, side effects or access with their healthcare professional.

They should not stop controller treatment simply because they feel better.

Develop a written asthma action plan

An asthma action plan explains what to do when symptoms are controlled, when they worsen and when emergency assistance is required.

Depending on the prescribed regimen, the plan may include instructions for adjusting medication, monitoring symptoms and recognizing danger signs.

The plan should be individualized, understood by the person with asthma and accessible to caregivers when appropriate.

Identify and manage triggers

Avoidance measures should focus on triggers that are relevant to the individual.

Examples include avoiding tobacco smoke, reducing exposure to known allergens and improving workplace controls for dust, fumes and chemicals.

Complete elimination of every environmental trigger is not always practical. Prevention strategies should be based on the person's symptoms and professional advice.

Monitor changes in symptoms

Increasing reliever use, night-time symptoms, worsening exercise tolerance or repeated attacks can indicate inadequate asthma control.

People with persistent symptoms may benefit from symptom tracking or peak-flow monitoring when recommended by their clinician.

Attend regular medical reviews

Regular reviews allow healthcare professionals to assess symptom control, inhaler technique, medication adherence and the risk of future exacerbations.

Anyone hospitalized because of an asthma attack should arrange appropriate follow-up after discharge.

10. Asthma in Children, Schools and Workplaces

Asthma management is particularly important in environments where other people may need to recognize symptoms and provide assistance.

Children

Children may struggle to describe breathlessness or chest tightness.

Instead, they may cough repeatedly, stop playing, become unusually quiet or appear more tired than normal.

Warning signs can include rapid breathing, pulling in of the skin around the ribs, difficulty speaking and unusual drowsiness.

Parents and caregivers should understand the child's asthma action plan, know where prescribed medication is kept and understand when emergency services should be contacted.

Schools

Schools should have clear procedures for responding to breathing emergencies.

Relevant staff should know how to recognize respiratory distress, access a child's prescribed medication, contact caregivers and activate emergency assistance when necessary.

A child who is struggling to breathe should never be dismissed as simply anxious or unwilling to participate in an activity.

Workplaces

Employers should assess relevant respiratory hazards and implement appropriate controls for smoke, dust, fumes and other irritants.

Staff should know how to activate the emergency response system, communicate the location of an incident and provide appropriate assistance within their level of training.

First aid training can help employees recognize medical emergencies, respond more confidently and support the person while waiting for professional medical care.

11. Common Myths About Asthma

Myth: Asthma only affects children.

Asthma can develop at any age. Symptoms may improve during some periods of life, but they can persist or return later.

Myth: A person cannot have a serious asthma attack without wheezing.

Wheezing is common but not always present. Severe breathlessness, exhaustion, confusion or reduced responsiveness are warning signs, even when wheezing is absent.

Myth: Every inhaler works in the same way.

Inhalers contain different medications and have different instructions. People should use their prescribed devices according to their treatment plan.

Myth: Medication is only necessary when symptoms occur.

Some asthma medications control airway inflammation and help prevent exacerbations. Stopping prescribed controller treatment without medical advice can increase risk.

Myth: People with asthma should avoid exercise.

Most people with appropriately managed asthma can exercise. Symptoms during activity should prompt an assessment and an individualized management plan.

Myth: Asthma is always caused by allergies.

Allergies are important triggers for some people, but asthma involves several clinical patterns and not everyone has an identifiable allergic trigger.

12. Frequently Asked Questions About Asthma

Is asthma a chronic lung disease?

Yes. Asthma is a chronic respiratory disease involving airway inflammation and variable airflow obstruction. Symptoms can fluctuate, and many people achieve good control with appropriate treatment.

Can an asthma attack be life-threatening?

Yes. Severe asthma attacks can cause critical airflow obstruction and respiratory failure. Severe or rapidly worsening breathing difficulties require urgent medical attention.

What should you do if someone has an asthma attack and no inhaler?

Help the person adopt a comfortable position, stay with them and call emergency services promptly if they have significant breathing difficulties. In Thailand, call 1669. Do not delay assistance while searching for medication.

Should you give an asthma patient water?

Water does not treat airway obstruction. Do not give food or drink to someone experiencing severe breathing difficulties or reduced consciousness.

Should a person with asthma lie down?

Help the person adopt a comfortable position, often sitting upright. Do not force them to lie flat if this worsens their breathing.

Can pollution trigger asthma symptoms?

Yes. Smoke and air pollution, including fine particulate matter, can aggravate symptoms in susceptible people. Follow local air-quality information and your healthcare professional's advice.

What is the difference between asthma and an asthma attack?

Asthma is the underlying chronic respiratory disease. An asthma attack is an episode in which symptoms and airflow obstruction worsen significantly.

Conclusion: Take Breathing Difficulties Seriously

Beth's hospitalization illustrates how a respiratory illness and persistent breathing difficulties can develop into a serious asthma emergency. Ellie's experience shows how environmental exposure, including secondhand smoke, can affect respiratory health and daily life.

Their stories reinforce an essential message: asthma should never be dismissed as a minor condition.

Asthma involves inflammation and narrowing of the airways, which can make breathing difficult. Although effective treatment is available, severe attacks can occur and may require urgent medical care.

Recognizing warning signs, following prescribed treatment, managing relevant triggers and maintaining an individualized asthma action plan can help reduce the risk of serious complications.

During an emergency, remain calm, help the person access their prescribed reliever medication, call emergency services when indicated and monitor their condition continuously.

If someone is experiencing severe breathing difficulties in Thailand, call 1669. Do not wait for the person to collapse.