context: An asthma attack is a sudden worsening of asthma symptoms caused by the tightening of muscles around your airways (bronchospasm). During the asthma attack, the lining of the airways also becomes swollen or inflamed and thicker mucus -- more than normal -- is produced. All of these factors -- bronchospasm, inflammation, and mucus production -- cause symptoms of an asthma attack such as difficulty breathing, wheezing, coughing, shortness of breath, and difficulty performing normal daily activities. Other symptoms of an asthma attack may include: Severe wheezing when breathing both in and out Coughing that won't stop Very rapid breathing Chest tightness or pressure Tightened neck and chest muscles, called retractions Difficulty talking Feelings of anxiety or panic Pale, sweaty face Blue lips or fingernails Or worsening symptoms despite use of your medications Call 911 if you have any of these symptoms. Some people with asthma may go for extended periods without having an asthma attack or other symptoms, interrupted by periodic worsening of their symptoms due to exposure to asthma triggers such as exercise or exposure to cold air. Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours after treatment. Severe asthma attacks are less common but last longer and require immediate medical help. It is important to recognize and treat even mild symptoms of an asthma attack to help you prevent severe episodes and keep asthma under control. Without immediate asthma medicine and asthma treatment, your breathing may become more labored, and wheezing may get louder. If you use a peak flow meter during an asthma attack, your reading will probably be less than your personal best. As your lungs continue to tighten during the asthma attack, you may be unable to use the peak flow meter at all. Gradually, your lungs may tighten so much during the asthma attack that there is not enough air movement to produce wheezing. This is sometimes called the "silent chest," and it is a dangerous sign. You need to be taken to a hospital immediately with a severe asthma attack. Call 911 for help. Unfortunately, some people interpret the disappearance of wheezing during the asthma attack as a sign of improvement and fail to get prompt emergency care. If you do not receive adequate treatment for an asthma attack, you may eventually be unable to speak and can develop a bluish coloring around your lips. This color change, known as "cyanosis," means you have less and less oxygen in your blood. Without immediate aggressive treatment in an emergency room or intensive care unit, you may lose consciousness and eventually die. Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These changes start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening. In general, these early asthma attack symptoms are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse. Early warning signs of an asthma attack may include: Frequent cough, especially at night Reduced peak flow meter readings Losing your breath easily or shortness of breath Feeling very tired or weak when exercising Wheezing or coughing during or after exercise (exercise-induced asthma) Feeling tired, easily upset, grouchy, or moody Decreases or changes in lung function as measured on a peak flow meter Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache) Trouble sleeping with nighttime asthma The severity of an asthma attack can escalate rapidly, so it's important to treat these symptoms immediately once you recognize them. If you or a loved one is experiencing an asthma attack and the symptoms do not quickly improve after following the asthma action plan, follow the "red zone" or emergency instructions and contact your doctor or call 911 right away. Immediate medical attention is necessary.