Watching someone have an asthma attack is terrifying. Often bystanders are reduced to standing helplessly with their mouths open and observing the asthmatic struggle, assuming that someone else will come to their aid. These precious minutes may make all the difference between life and a fatal asthma attack, so it is crucial that everyone, including children and non-asthmatics, know how to help.

1) Recognize the problem!—Early in an asthma attack, asthmatics may complain that their chest feels tight or appear restless. Children in particular may cough instead of having obvious wheezing. As the attack develops, the individual may start to hyperventilate and wheeze. Sometimes it’s hard to tell the difference between a panic attack and an asthma attack—ask the person if they have asthma! If it is too hard to tell, be safe and assume that it is an asthma attack. The asthmatic may develop retractions, where the muscles in between the ribs or around the collar bone may appear to “cave in.” They may have difficulty speaking in full sentences. If the asthmatic stops wheezing, but still appears to be having trouble breathing, this may be a sign of a fatal “silent attack.” This occurs when the airways are so constricted that very little air is getting by, so the person is unable to even wheeze.

2) Remove them from the source if needed.—If there are obvious triggers in the area such as smoke, pollen or strong odors, remove the individual from the area if possible.

3) Have the person sit, not lie down.—Most asthmatics find it easier to breathe sitting up. Straddling a chair backwards with their arms leaning against the top of the chair may be a more comfortable position. Have them try to control their breathing by breathing in through their nose instead of their mouth.

4) Get an inhaler ASAP!—Ask the person if they have an inhaler. If they don’t have their inhaler with them, it’s OK to use someone else’s in an emergency. This is the most important step! Getting the necessary medication into their lungs immediately is crucial in keeping symptoms from worsening. Help them put the inhaler between their lips and give them 2-4 individual puffs. Let them know when you are going to release the puff and have them take a deep slow breath as you release the medication. Repeat the process in 5-10 minutes as needed.

5) Don’t use a paper bag. Having the person breathe into a paper bag to rebreathe their exhaled air is only helpful if you are certain that they are having a simple panic attack. Exhaled air does not contain as much oxygen, so having an asthmatic rebreathe their air will make them worse.

6) Use a spacer if available.—Often asthmatics have trouble taking a deep breath to take their inhaled medications properly because they are hyperventilating. In this case, a spacer, a plastic device that fits over the end of the inhaler that prevents the medication from dissipating into the air may be helpful. Release the medication into the chamber instead, letting the individual take four or five breaths with their lips around the end of the spacer. If no spacer is available, it may be possible to improvise using a paper tube or cutting a hole in the end of a small plastic bottle or paper cup instead to create a similar effect.

7) Stay calm!—As an asthmatic struggles to breath, they often panic and breathe even harder, making the situation even worse. It is very important for those assisting to stay calm and reassure them that everything is under control.

8) Call for help!—If the person is not showing any improvement or are worsening after ten minutes or if they are having difficulty walking or talking or if their lips, tongue, or fingernails are turning bluish-grey, call for an ambulance immediately. Ignore the asthmatic if they insist that you not call for help—lack of oxygen to their brain may be clouding their judgment!

Knowing these eight steps will help you feel confident in an asthma emergency and may even save a life!