What is the best position for an asthma attack?

Many people with asthma use rescue inhalers during an ”attack” to help open airways. Changing body position can also help improve airflow. It can help to sit up straight or stand instead of lying down or slouching.

Asthma can affect sleep, but your sleep position, such as on your side or back, can also help with breathing. 

For long-term asthma management, consider speaking with a doctor or healthcare professional about the right combination of rescue, ongoing medications, and lifestyle changes.

Managing an asthma attack

During an asthma attack, consider taking the following steps:

• Try to stay calm.
• Sit up straight.
• Take a puff of your rescue inhaler.
• Call 911 if symptoms don’t get better.

You might feel like you want to lie down during an asthma attack, but this can make it difficult for you to breathe. Try to sit up or even stand up to help open your airways.

A small 2017 study of 20 people with bronchial asthma found that forced expiratory volume (FEV) and forced vital capacity (FVC) were greater in the standing position compared to sitting or lying down on your back.

Can asthma get worse when you sleep? 

Some people experience a worsening of asthma symptoms when they try to sleep. 

Lung function slows down at night, and the upper airway narrows, leading to greater lung resistance. Also, there may be greater exposure to allergens like dust from the mattress or bedding. You may also have a delayed response to allergens like pet hair and pollen from earlier in the day. Cold air coming into the bedroom can also cause your airways to contract.

Sleeping position

Your sleeping position can also affect asthma symptoms.

Lying on your side or your stomach might restrict your lung capacity, and lying on your back might cause mucus to drip into your throat, leading to a cough. 

However, the correct position might depend on the person. An older case study published in 2016 found a man’s bronchial asthma symptoms improved when he started sleeping on his back. 

Here are some options for sleep positions that might help you breathe better at night:

• Sleep on your left side with a pillow between your legs. This position can reduce acid reflux which often triggers asthma.
• Sleep on your back with your head and shoulders elevated. This position can open the airways and help the sinuses to drain normally.
• Sleep on your back with your head elevated and a pillow under your knees. This position can improve circulation and keep the body stable.

To improve your sleep quality, you may also want to practice good sleep hygiene by:

• closing windows to protect against air pollution and temperature changes
• reducing allergens and regularly vacuuming, dusting, and washing bedsheets
• keeping pets outside of the bedroom

De-stressing techniques, like relaxation and soft music before bed, may also help with sleep.

Is it ok to use an inhaler before going to sleep?

You can use an inhaler before you go to sleep.

You may also want to keep your asthma medication beside the bed so you can easily reach for it.

Common asthma drugs for flare-ups

When you are having an asthma episode, you might use a quick-relief medication. These drugs relax and open your airways so you can breathe better. They are sometimes called bronchodilators.

If you have a severe episode, your doctor may also prescribe oral corticosteroids.

Quick-acting bronchodilators include short-acting beta-agonist medications. Examples include:

• albuterol (ProAir HFA, Ventolin HFA) 
• levalbuterol (Xopenex HFA) 
• pirbuterol (Maxair)

Corticosteroids for severe symptoms or attacks include:

• prednisone (Rayos)
• methylprednisolone 

Doctors don’t usually recommend taking steroids long term because of their side effects.

If you must use your inhaler a few times per week or even daily, speak with your doctor or healthcare professional about your options to manage asthma better.

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Common drugs for asthma management

There are many options for managing asthma, including inhaled and oral medications. Some of the most common are:

Inhaled corticosteroids

• fluticasone (Flovent Diskus, Flovent HFA)
• budesonide (Pulmicort Flexhaler)
• mometasone (Asmanex)
• ciclesonide (Alvesco)
• flunisolide (Aerobid)
• beclomethasone (Qvar Redihaler)

Combination inhalers (corticosteroids plus long-acting beta-agonists)

• fluticasone and salmeterol (Advair Diskus, Advair HFA)
• fluticasone and vilanterol (Breo Ellipta)
• budesonide and formoterol (Symbicort)
• mometasone and formoterol (Dulera)

Anticholinergics 

• tiotropium (Spiriva, Stiolto Respimat) 

Leukotriene modifiers

• montelukast (Singulair)
• zafirlukast (Accolate)
• zileuton (Zyflo, Zyflo CR)

Biologic treatments

Biologic treatments are also available for severe asthma. These may help people whose asthma is difficult to manage with inhaled corticosteroids or long-acting medications. Examples include:

• omalizumab
• dupilumab
• mepolizumab
• reslizumab 
• benralizumab
• tezepelumab

Biologic treatments are specific to the type of asthma and might not be the correct treatment for everyone. 

When to contact a doctor?

If you have frequent asthma episodes, you may want to speak with a doctor or healthcare professional. Using a rescue inhaler more than a couple of times a week shows your asthma may not be under control.

A doctor or an allergist can help develop the correct treatment plan that includes long-acting medications and lifestyle modifications.

A 2019 review found that increasing fruits, vegetables, and whole grains in your diet, and increasing exercise, can improve asthma control and lung function.

Summary

Body position can affect airflow into the lungs, and during an asthma attack, you may consider standing or sitting up straight.

Sleep in a position that opens your lungs and prevents asthma triggers like acid reflux and nasal mucus. You may try sleeping on your side or back to help with breathing.

Consider working with a healthcare team to find the right mix of medications and lifestyle adaptations for long-term asthma control.

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