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Ascertain the casualty’s medical history of asthma and check the availability of their personal Asthma Action Plan, their asthma reliever medication and their spacer. Likely they will have these items on them, or nearby. In a school, for example, the teacher will have these items in an easy-to-access location. An adult in a workplace may carry these items with them or have them in their desk. If you can’t access their personal device, or the don’t have one, check the workplace first aid kit for a general use device.

If no device is available, call emergency services for advice.
Once an asthma device is obtained, proceed to assist or administer the medication using the 4x4x4 Technique - 1 puff, 4 breaths, 4 times, 4 Minutes.

4x4x4 Technique With Spacer
• Shake inhaler (before each puff) and insert mouthpiece into spacer.
• Place spacer mouthpiece in casualty’s mouth and give 1 puff of a blue/ grey reliever puffer, then ask the casualty to breathe in and out, through the spacer FOUR times.
• Repeat until FOUR puffs have been given.
• Wait FOUR minutes. If there is little or no improvement, repeat the above sequence.
• If still no improvement, call Triple Zero (000) and inform them that someone is having an asthma attack. Continue the sequence every FOUR minutes.

4x4x4 Technique Without Spacer
• Shake inhaler (before each puff).
• Place inhaler mouthpiece in casualty’s mouth and give 1 puff of a blue/ grey reliever puffer, then ask the casualty to hold that breath for FOUR seconds.
• Repeat until FOUR puffs have been given.
• Wait FOUR minutes. If there is little or no improvement, repeat the above sequence.
• If still no improvement, call Triple Zero (000) and inform them that someone is having an asthma attack. Continue the sequence every FOUR minutes.

If the casualty collapses during the incident:
• Call Triple Zero (000) for an ambulance.
• If possible, assist with FOUR puffs of a reliever.
• If little or no immediate improvement repeat reliever medication every FOUR minutes until the ambulance arrives.
• Be calm and reassuring.
• Continue to monitor, if unconscious and not breathing normally, commence CPR.

It is important to stay with the casualty and continually monitor their condition throughout this process. The severity of the situation may increase unexpectedly – be alert for signs that immediate emergency assistance is required. This may include:
• Casualty cannot breathe normally, or is not breathing at all, following administration of asthma reliever medication
• Casualty displays signs of an asthma emergency, including:
o Severe shortness of breath, can’t speak comfortably or lips look blue
o Symptoms worsening very quickly
o Casualty receives little or no relief from administration of reliever medication

Should any of these be observed, call emergency services without delay and inform them that it is an asthma emergency.

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