Reviewed: 27 April 2026
Most people know to reach for an inhaler during an asthma attack. But what do you do when the inhaler isn't helping, symptoms are getting worse, and you're not sure whether to call 000? That moment — when the relief should be kicking in and it isn't — is when correct first aid knowledge matters most.
This guide covers the correct asthma first aid steps as recommended by Asthma Australia and ANZCOR, what to do when a spacer isn't available, how to recognise a life-threatening attack, and specific considerations for neurodiverse children who may present and communicate differently during an episode.
Make sure your kit includes a medication storage section for an inhaler and spacer.
Family First Aid Kit Find My KitWhat Australians Need to Know About Asthma First Aid
According to Asthma Australia, approximately 2.8 million Australians have asthma — making it one of the most common chronic conditions in the country. Despite this prevalence, asthma deaths still occur in Australia each year, and many of these are preventable with correct early management.
The key factor in preventable asthma deaths is not the severity of the underlying condition — it is a delay in appropriate treatment. People and carers who are uncertain about the correct steps, who wait to see if symptoms improve on their own, or who don't know when to escalate to 000 are at greater risk of a fatal outcome.
Recognising an Asthma Attack — Signs to Watch For
Asthma attacks range from mild to life-threatening. Recognising where on that spectrum a person is determines whether you manage it with a puffer at home or call 000 immediately.
Mild to Moderate Attack
- Mild wheeze or cough
- Some shortness of breath but still able to speak in full sentences
- Able to walk without stopping
- Breathing faster than normal but not laboured
Severe Attack — Call 000
- Severe wheeze or very little wheeze due to minimal air movement
- Cannot speak in full sentences — only words or short phrases
- Skin sucking in at the neck or between ribs with each breath
- Lips or fingernails turning blue
- Extreme distress, exhaustion or collapse
- No relief from reliever inhaler after 4 puffs
First Aid Steps for Asthma Attack — As per ANZCOR and Asthma Australia
The four-step asthma first aid rule from Asthma Australia is the standard approach for a mild to moderate attack in Australia.
- Sit the person upright. Help them into a comfortable upright sitting position. Do not lay them down — this makes breathing harder. Stay calm and encourage them to breathe slowly.
- Shake the reliever inhaler and give 4 separate puffs. Use a spacer if available — it significantly improves the amount of medication reaching the lungs. Give one puff at a time, with 4 slow breaths after each puff.
- Wait 4 minutes. If there is no improvement after 4 minutes, give another 4 puffs in the same way.
- If still no improvement after 8 puffs — call 000. Call an ambulance immediately. Continue giving 4 puffs every 4 minutes while waiting. A total of 12 puffs can be given while awaiting the ambulance.
- If the person is not breathing — begin CPR. Follow ANZCOR guidelines — 30 compressions to 2 rescue breaths. Use a CPR barrier mask from your first aid kit.
When You Don't Have a Spacer — The Coffee Cup Hack
A spacer dramatically improves the effectiveness of a reliever inhaler by slowing the aerosol and making it easier to inhale fully — especially important for children and anyone in respiratory distress. But what if you don't have one?
Samantha demonstrates an improvised spacer technique using a paper or polystyrene cup. Watch the video:
Make a small hole in the base of a paper cup, insert the mouthpiece of the inhaler through the hole, place the open end of the cup over the person's nose and mouth, and give puffs in the same four-breath sequence. This improvised method significantly improves medication delivery compared to using the inhaler alone without a spacer.
Read the full guide: How to Improvise a Spacer for an Asthma Attack — Coffee Cup Method →
Asthma attacks are frightening for any child. For a neurodiverse child, the combination of physical distress, loss of breath control, the sensation of a face mask or spacer, and the urgency in the adults around them can escalate distress significantly — which in turn worsens the airway constriction.
Preparing before an attack: Familiarise the child with the inhaler, spacer, and the cup method during calm moments — not for the first time during an emergency. Use visual schedules or social stories to explain what an attack feels like and what will happen. For children who use AAC devices or communication cards, include an asthma emergency card in their communication kit.
During an attack: Reduce sensory input where possible — move to a quieter space, reduce crowd, lower your voice. Use concrete, predictable language: "I am helping you breathe. Take a slow breath with me." Avoid reassurances like "relax" or "calm down" — give a clear physical cue instead. Count out loud — "one, two, three, four" — to give the child a concrete breathing anchor.
Spacer and mask aversion: Some neurodiverse children refuse a spacer or face covering due to sensory aversion. Practise with the spacer during play so the sensation is familiar before an emergency. If a child absolutely cannot tolerate the spacer, use the inhaler without it and continue attempting with the improvised cup method — the wider opening may be more tolerable than a fitted mask.
For broader guidance: What to Pack When You Leave Home with a Neurodiverse Child →
What to Keep in Your Kit for Asthma Preparedness
Your first aid kit should support asthma management alongside a person's prescribed medications. Key items:
- Dedicated medication storage — keep the prescribed reliever inhaler, spacer, and Asthma Action Plan together in the kit
- Paper cups — for the improvised spacer technique if the real spacer is not available
- CPR barrier mask — in case the attack progresses to respiratory arrest
- Asthma Action Plan — the individual's plan should be kept with the kit at all times, not in a separate location
The Assurance Family First Aid Kit and Family 4WD Outdoor Kit both include a personalised medication section — keeping the inhaler, spacer and Asthma Action Plan with your first aid supplies so everything is in one accessible place.
Family First Aid Kit → 4WD Outdoor Kit →Frequently Asked Questions
What do you do if an asthma puffer isn't working?
Should you call 000 for an asthma attack?
Is a spacer necessary for an asthma puffer?
What is the difference between a reliever and a preventer inhaler?
How do I help a neurodiverse child during an asthma attack?
Is Your Kit Ready for an Asthma Emergency?
Keep inhaler, spacer and Asthma Action Plan with your first aid kit — always together, always accessible.
Family First Aid Kit → All Home Kits → Find My Kit →References
Asthma Australia — Asthma first aid four-step rule (asthma.org.au)
Australian Resuscitation Council — ANZCOR Asthma Guidelines (resus.org.au)
Royal Children's Hospital Melbourne — Asthma first aid (rch.org.au)
Sydney Children's Hospitals Network — Asthma management (schn.health.nsw.gov.au)
Better Health Channel — Asthma first aid (betterhealth.vic.gov.au)
