An asthma exacerbation can happen anytime anywhere, so it’s best to keep all emergency asthma medications with you at all times. However, there may be instances when you forget or lose your reliever medications. Here are some ideas you can try to manage an asthma flare when you can’t find your inhaler.

Decide if You Need to Visit the ER
If you’re peak flow is 60% of your normal, head immediately to the emergency room (ER). Additional signs you need to visit the ER include bluish/grayish lips or fingernails (cyanosis), uncontrolled coughing or wheezing, soreness/tightness around ribs, feel like you’re having a panic attack, exhausted from breathing, having trouble saying a few words, trouble standing up. Don’t wait, as asthma attacks generally don’t get better over time. Attacks can rapidly worsen—head to the ER.

Move Away from Triggers
Move away from any asthma triggers that are causing your reaction—smoke, perfume, chemical odors, dust, pet, mold, smoke. Trying breathing through 2-3 folded tissues held over your nose and mouth. A scarf, sleeve or jacket collar covering your nose and mouth may also filter out triggers to make breathing easier.

Take a Decongestant, Expectorant or Antihistamine
A decongestant (such as PE [phenylephrine HC1 10 mg]) and/or an expectorant (guaifenesin/Mucinex) or a medication that’s a combination of the two may help. Many cold and flu medications have this combination of medications. Decongestants and expectorants work to loosen and thin mucus, making it easy to make a cough productive, drain sinuses and reduce airway inflammation. Be sure to stay hydrated when using these medications.

Antihistamines, such as Benadryl, Claritin or Zyrtek may be taken when asthma symptoms first begin. This works best for those who have allergic asthma. Benadryl ultratabs, liqui-gels or liquid will work faster than tablets.

Dark Chocolate, Cola, Black Coffee or Tea
Dark chocolate, cola, black coffee, tea and energy drinks all contain caffeine, theobromine and other substances that can help during an asthma flare or attack. Caffeine and theobromine work as bronchodilators, which relax the airways—making it easier to breathe. Hot black coffee and tea are generally recommended, but you can also try energy drinks. You might also eat some dark chocolate to increase the effect. You may experience some side effects, such as shaking, increased respiration and feel jittery from this combination.

Focused Breathing
Breathing exercises should be part of everyone’s asthma management plan; such exercises can also be used during an asthma attack. Focused breathing causes you to relax and reduce anxiety, leading to longer, deeper breathes which oxygenate the blood. The Buteyko and Papworth breathing methods are two of the most often taught.

Another option is pursing your lips as you exhale; this helps to slow exhalation and keep airways open. This technique was taught to me at by a respiratory therapist at National Jewish Research Hospital in Denver.

Steam or Cool Mist
Steam or cool mist may help during an asthma attack. Steam works to loosen mucus and add moisture to the air. Cool air also adds moisture to dry air, but may not work as well to loosen mucus. Be sure to avoid using steam if humidity is one of your asthma triggers.

Magnesium and/or Vitamin C
Magnesium acts as a bronchodilator , while vitamin C has a low antihistamine effect. These supplements are most useful when taken at the first signs of an asthma flare or attack. After that point, it will be too late for the supplements to take effect.

Recommended dose:
Adults: 500 mg of magnesium and 1,000 mg of vitamin C
Children 10-17 years of age: 250 mg of magnesium and 500 mg of vitamin C
Children 5-9 years of age: 167 mg of magnesium and 333 mg of vitamin C

Sit Up and Stay Calm
Sit upright—bending over or lying down constricts your breathing. Sitting upright opens your chest and creates more space for your diaphragm to work, making easier to breathe.

Stay calm—if you panic during an asthma attack, your breathing will become even more difficult. Staying calm, breathing slowly and deeply will make it easier to breathe.

Be Prepared
Always being prepared is the best way to help yourself when asthma worsens. Some ideas to help you be prepared:

1). Keep an inhaler with you at all times. Carry one in your purse, backpack or brief case every day. You might consider using a special inhaler case or other type of bag to keep track of an inhaler.

2). Keep an epi-pen with you at all times.

3). Store extra inhalers at work, school, in the car, etc. in case you lose or forget your rescue inhaler.

4). Keep an allergy mask with you at all times, if you have allergic asthma.
5). Keep cola and chocolate available when traveling.

6). Keep an antihistamine, decongestant and/or an expectorant with you when away from home.

These are a few ideas that may help during an asthma flare or attack and you’re without an inhaler. You never know when an asthma flare or attack will strike. The best practice is to always be prepared and follow your asthma management plan every day.

Be sure to check with your doctor before trying any of these methods during an asthma attack. Follow your doctor’s recommendations for asthma management, use your action plan every day and ask your doctor how to handle asthma flares and attacks.

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