Asthma at Work: Spotting an Attack and What to Do
Sit them up, one puff every 30 to 60 seconds up to ten puffs, and call 999 if they are no better. The emergency steps, plus the occupational triggers employers miss.
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Quick answer
If someone is having an asthma attack: sit them up straight and keep them calm — do not let them lie down. Help them take one puff of their reliever inhaler every 30 to 60 seconds, up to a maximum of ten puffs, shaking the inhaler each time. Call 999 if they feel worse at any point, if they are no better after ten puffs, or if they do not have their reliever inhaler with them. If the ambulance has not arrived after 10 minutes and they are not improving, repeat the ten puffs. Asthma affects 7.2 million people in the UK — about 8 in every 100.
Most people know somebody with asthma and assume it is a minor condition. For most of them it is well controlled. But asthma attacks still kill people in the UK every year, and a colleague who knows what to do in the first few minutes genuinely changes the outcome.
The emergency sequence, step by step
| Step | What to do | Detail |
|---|---|---|
| 1 | Sit them up straight | Keep them calm. Loosen tight clothing around the neck. Do not let them lie down |
| 2 | Reliever inhaler — usually blue | One puff every 30–60 seconds, up to 10 puffs. Shake before each. Use a spacer if they have one |
| 3 | Call 999 | If they feel worse at any point, if no better after 10 puffs, or if you are worried at any stage |
| 4 | Ambulance not arrived after 10 min? | If symptoms are not improving, repeat step 2 |
| 5 | Still no better? | Call 999 again immediately |
If they do not have their reliever inhaler with them, call 999 straight away. Do not spend time hunting for one.
Stay with them throughout. If they become unresponsive and are not breathing normally, start CPR and send someone for a defibrillator.
What an asthma attack looks like
Asthma narrows and inflames the airways. During an attack the muscles around the airways tighten, the lining swells and produces mucus, and breathing out becomes progressively harder.
Signs a colleague may be having an attack:
- Coughing, wheezing or a tight chest
- Breathlessness — struggling to get a full breath
- Difficulty speaking in full sentences
- Their reliever inhaler is not helping, or is needed more often than every four hours
- Obvious distress, hunching forward, using shoulders and neck to breathe
The signs people misread
| What you see | What people assume | What it may actually mean |
|---|---|---|
| Wheezing has stopped | They are getting better | A silent chest in someone still distressed is a serious sign — too little air is moving to make a noise |
| Cannot finish a sentence | They are panicking | A recognised marker of a severe attack |
| Just a persistent cough | A cold | Cough can be the main symptom, particularly in children |
| Calm and quiet | Settling down | Exhaustion and drowsiness in an ongoing attack are danger signs — call 999 |
| Blue lips or fingertips | Cold | Dangerously low oxygen — 999 immediately |
Afterwards
Anyone who has had an asthma attack should contact their GP surgery for a follow-up appointment — even if they feel completely fine again. An attack is a signal that their asthma control needs reviewing, and the follow-up is how the next one gets prevented.
As an employer, that is worth actively supporting rather than leaving to the individual: someone who has just had a frightening episode at work and been sent home will often not book anything.
Reliever, preventer and spacer — what is what
| Inhaler | Typically | What it does | In an attack |
|---|---|---|---|
| Reliever | Usually blue | Opens the airways quickly | This is the one — one puff every 30–60 sec, up to 10 |
| Preventer | Often brown, orange, red or purple | Reduces inflammation over time, taken daily | Not the emergency inhaler |
| Spacer | Plastic chamber | Holds the dose so more reaches the lungs | Use it if available — it makes each puff more effective |
Colour is a useful clue, not a rule — some people are on combination inhalers or a MART regime where the same device is used differently. What matters practically is that the person, or their asthma action plan, knows which one is the reliever.
Common triggers at work
Triggers vary enormously between individuals, which is why a personal asthma action plan matters more than any general list. Ones that show up in workplaces:
- Dust, including from cleaning and building work
- Chemicals, fumes, solvents and cleaning products
- Flour, wood dust, isocyanates and other known occupational sensitisers
- Cold air, including walk-in chillers and loading bays
- Colds, flu and other respiratory infections
- Exercise and physical exertion
- Stress and anxiety
- Animals, pollen and mould
Occupational asthma
If someone’s symptoms are noticeably better away from work and worse when they return — improving at weekends and on holiday, deteriorating within days of going back — that pattern is worth taking seriously. It is the classic presentation of occupational asthma.
Two duties follow. Occupational asthma is reportable under RIDDOR when a doctor diagnoses it in connection with the person’s work. And controlling exposure to respiratory sensitisers is a COSHH duty — it belongs in your risk assessment, controlled at source rather than by handing out masks.
Sectors where this comes up most: baking and food manufacturing (flour dust), woodworking, motor vehicle repair (isocyanates in paint), healthcare and cleaning (latex, chemicals), agriculture, and any process generating fine dust or fumes.
What employers can do
- Let people keep their reliever inhaler on them, not locked in a locker or a desk drawer on another floor. This single point has probably prevented more bad outcomes than any other.
- Know who has asthma and, with their consent, make sure first aiders know too.
- Ask about their asthma action plan. Many people with asthma have a written plan from their GP or asthma nurse; knowing it exists and roughly what it says helps enormously.
- Include respiratory sensitisers in your COSHH assessment and control exposure at source.
- Take reported symptoms seriously, particularly any that improve away from work.
- Think about triggers you control — aerosol cleaning products, strong fragrances, dusty building work, cold stores.
- Make sure first aiders have practised this. The ten-puff protocol is easy to forget under pressure, and counting to ten while someone is frightened is harder than it sounds.
Training
Asthma is covered on the three-day First Aid at Work course and on paediatric first aid, where childhood asthma is a common presentation. It is not covered in depth on the one-day EFAW course — worth knowing if you have employees with asthma and have only trained people to that level. See 1 day or 3 days?
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First Aid at Work Group Course
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First Aid at Work ReQual Open Course
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Paediatric First Aid Group Course
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Frequently asked questions
Sit them up straight, keep them calm, and help them take one puff of their reliever inhaler every 30 to 60 seconds up to a maximum of ten puffs, shaking the inhaler each time. Call 999 if they get worse, if they are no better after ten puffs, or if they do not have their inhaler.What should you do if someone is having an asthma attack?
No. Lying down makes breathing harder. Sit them up straight and loosen any tight clothing around the neck.Should someone having an asthma attack lie down?
One puff every 30 to 60 seconds, up to a maximum of ten puffs. If the ambulance has not arrived after 10 minutes and symptoms are not improving, the ten puffs can be repeated.How many puffs of a reliever inhaler in an asthma attack?
If the person feels worse at any point, if they are no better after ten puffs of their reliever inhaler, if they do not have their inhaler with them, or if you are worried at any stage. Call again if they are still no better after repeating the puffs and the ambulance has not arrived.When should you call 999 for asthma?
7.2 million people in the UK have asthma, according to Asthma + Lung UK — about 8 in every 100 people.How many people in the UK have asthma?
No, the opposite. If someone is still visibly distressed but the wheezing has stopped, it can mean too little air is moving to make a sound. Treat it as a serious sign and call 999.Is a silent chest a good sign in an asthma attack?
The reliever is usually blue and opens the airways quickly; preventers are taken daily and are often brown, orange, red or purple. Colour is a clue rather than a rule, since some people use combination inhalers — what matters is that the person or their asthma action plan knows which is which.Which inhaler is the reliever?
In an emergency, helping someone use their own reliever inhaler is standard first aid practice. Using someone else’s inhaler is a different question and one to raise with your occupational health or medical adviser rather than decide on the day. If there is no inhaler available, call 999 straight away.Can you help someone use an inhaler that is not prescribed to them?
Yes. Occupational asthma is reportable under RIDDOR where a doctor diagnoses it in connection with the person’s work. Controlling exposure to respiratory sensitisers is also a duty under the COSHH Regulations.Is occupational asthma reportable?
The classic pattern is symptoms that improve away from work — at weekends and on holiday — and worsen within days of returning. If an employee reports that pattern, it should be investigated rather than dismissed, and they should see their GP.How do I know if asthma is work-related?
Not in depth. Asthma is covered on the three-day First Aid at Work course and on paediatric first aid. If you have employees with asthma and have only trained people to EFAW level, that is worth reviewing.Does a one-day first aid course cover asthma?
Make sure your first aiders have practised this
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Asthma is one of the major illnesses covered on the three-day First Aid at Work course. Whether your workplace needs that level is decided by a first aid needs assessment.
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