Emergency: If you or someone you're with cannot speak in full sentences, is visibly struggling to breathe, has blue-tinged lips or fingertips (cyanosis), is using neck and stomach muscles to breathe, or is not improving after 4–8 puffs of reliever inhaler — this is a life-threatening asthma attack. Call for emergency assistance immediately or go to your nearest emergency department. Emergency contacts are on the back of your medical aid card. View AURA emergency contacts →
Recognising a Severe Asthma Attack
Not every worsening of asthma is an emergency. Knowing the difference can save your life.
Mild-moderate worsening: Increase in symptoms (more wheeze, tighter chest). Still able to speak in sentences. Peak flow 50–70% of personal best. Can treat at home with reliever inhaler and early follow-up.
Severe attack: Cannot complete sentences. Breathing is rapid and laboured. Peak flow below 50% of personal best. Reliever giving minimal relief. Get to hospital.
Life-threatening (status asthmaticus): Cyanosis (blue lips/fingertips). Silent chest (no wheeze sounds — the airways are so tight even wheeze disappears). Exhaustion, confusion. Respiratory or cardiac arrest risk. Call emergency services immediately.
If You're Having an Attack Right Now
Use your asthma action plan. If you have a written plan from your doctor, follow it now. If not:
- Sit upright. Do not lie down.
- Shake your reliever inhaler (salbutamol) and use it with a spacer if available: 4 puffs, one at a time, breathing in slowly and holding for 4 seconds between each. Wait 4 minutes.
- If no improvement after 4 puffs: take 4 more puffs. If still no improvement after 8 puffs total — go to hospital immediately. Take your inhaler with you.
- If no reliever inhaler is available: call emergency services. Do not delay.
- Call ahead to the emergency room if possible — tell them it's an acute asthma attack so they can prepare.
Scenario 1: Acute Asthma Requiring Emergency Treatment
This is an attack that doesn't respond to your home reliever therapy and requires emergency room treatment.
In hospital: Nebulised salbutamol and ipratropium bromide; oral or IV corticosteroids; oxygen; monitoring. Most patients respond within 1–4 hours and can be discharged. Those who don't respond are admitted (1–2 days typically).
Costs in private hospital: Approximately R15,000–R25,000 for an ER visit + 1–2 day admission. Emergency physician shortfall + pulmonologist consult shortfall above scheme rate: can be R3,000–R10,000.
Scenario 2: Status Asthmaticus (Life-Threatening, ICU Required)
This is a severe, prolonged asthma attack that does not respond to standard emergency treatment. It requires ICU admission, potentially non-invasive ventilation (NIV) or mechanical ventilation (intubation). Life-threatening.
Risk factors for fatal asthma: previous ICU admission for asthma; recent course of oral steroids; poor adherence to controller inhaler; overuse of reliever without controller; psychosocial factors (poverty, depression, chaotic household).
Costs in private hospital: ICU admission for status asthmaticus: R80,000–R150,000+. Pulmonologist in ICU, ICU specialist, anaesthesiologist if intubated — each bills separately. Specialist shortfall risk: R10,000–R40,000.
The Gap Cover Picture
| Scenario | Private hospital cost | Specialist shortfall risk |
|---|---|---|
| ER + 1–2 day admission (acute attack) | R15,000–R25,000 | R3,000–R10,000 |
| ICU (status asthmaticus) | R80,000–R150,000 | R10,000–R40,000 |
Gap cover closes the specialist shortfall — the gap between what a pulmonologist or emergency physician charges and what your scheme pays. Without gap cover, that difference is paid out-of-pocket at a time when you are least able to deal with it.
What to Do If You're Already Admitted
- Notify your scheme's pre-authorisation line as soon as possible (or have a family member do this) — the number is on your medical aid card.
- Note every specialist who treats you — pulmonologist, emergency physician, anaesthesiologist — each bills separately.
- Ask the nursing staff for a copy of your medication chart and specialist visit record before discharge.
- Request itemised accounts from hospital and each specialist before paying anything.
- Submit your gap cover claim once you have accounts — the claims process typically requires scheme payment advice plus specialist invoice.
Preventing the Next Attack
After an acute admission, your asthma management should be reviewed in full: - Are you on the right dose and type of controller inhaler? - Is your inhaler technique correct? - Have your triggers been identified and addressed? - Do you have an updated written asthma action plan?
The most common reason for repeated acute admissions is suboptimal controller use. The controller inhaler prevents attacks. The reliever treats them. If you're relying on your reliever more than twice a week, your asthma is not controlled — and your attack risk is elevated.
Let's focus on what we can control: daily controller use, correct technique, trigger avoidance, and a written action plan updated at every GP visit. These things work. They prevent emergency admissions. They save lives.
Check your scheme's cover for acute asthma →
If you are having an acute asthma attack right now: stop reading, use your reliever inhaler immediately, and call for help if it doesn't work. Emergency contacts are on the back of your medical aid card. View AURA emergency contacts →