Breathing
Asthma Attack — 4 x 4 x 4 Plan
Sit the person upright, give 4 puffs of a blue reliever puffer through a spacer (1 puff at a time, 4 breaths each), wait 4 minutes, repeat if no improvement. Call 000 if symptoms do not improve.
Sit the person upright, give 4 puffs of a blue reliever puffer through a spacer (1 puff at a time, 4 breaths each), wait 4 minutes, repeat if no improvement. Call 000 if symptoms do not improve.
Recognise an asthma attack
- Wheezing, persistent cough, tight chest
- Difficulty speaking in full sentences
- Anxiety, pale, sweaty skin
- Blue lips, exhaustion — call 000 immediately
Asthma First Aid Plan (4 x 4 x 4)
- Sit the person upright. Stay calm and reassuring.
- Give 4 separate puffs of a blue/grey reliever (e.g. Ventolin, Asmol) — one puff at a time, taking 4 breaths from a spacer after each puff. Use a spacer if available.
- Wait 4 minutes.
- If there is no improvement, give another 4 puffs.
- If there is still no improvement, call 000 and keep giving 4 puffs every 4 minutes until the ambulance arrives.
Severe attack — call 000 first
Call 000 immediately if:
- The person is struggling to breathe.
- Their lips look blue.
- They have collapsed.
- There is no reliever available.
While waiting for the ambulance, keep giving 4 puffs every 4 minutes.
Adrenaline (anaphylaxis with asthma)
If the person also has an EpiPen and a known severe allergy, give the adrenaline first, then the asthma reliever. See anaphylaxis.
Questions & answers
What is the 4x4x4 asthma first aid plan?
Give 4 separate puffs of a blue reliever through a spacer (one puff, 4 breaths each), wait 4 minutes, then repeat 4 more puffs if there's no improvement. Call 000 if no improvement after the second round.
Can I use someone else's blue puffer in an emergency?
Yes. In a severe asthma attack giving a reliever is always better than waiting — short-term use is safe even for someone without diagnosed asthma.
When is asthma a 000 emergency?
If the person is having difficulty speaking, lips are turning blue, the reliever isn't helping, symptoms get worse quickly, or they become drowsy or unconscious.
Related topics
Anaphylaxis
Anaphylaxis is a life-threatening allergic reaction. Lay the person flat, give adrenaline (EpiPen) immediately, call 000, and give a second dose after 5 minutes if there is no improvement.
Mild to Moderate Allergic Reactions
For mild allergic reactions — hives, swelling of the lips or face, tingling — remove the trigger if known, give antihistamines if prescribed, and watch closely for any sign of anaphylaxis.
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