Asthma first aid Australia — the 4x4x4 reliever steps

Reviewed by the Medibc First Aid Team — last updated July 2026. This is general first aid information, not a substitute for an accredited first aid course or professional medical advice. In an emergency, call 000.

An asthma attack can escalate quickly, so knowing the first aid steps matters — even if you don’t have asthma yourself. Asthma Australia promotes a simple, easy-to-remember plan known as 4×4×4. You do not need to be sure it is asthma to help — giving reliever puffs will not harm someone if it turns out not to be an asthma attack.

Signs of an asthma attack

Look for difficulty breathing, wheezing, a tight chest, a persistent cough, and being unable to speak comfortably in full sentences. Signs of a severe attack include gasping, the reliever not helping, blue lips, or the person becoming distressed or drowsy — this is a medical emergency.

Asthma first aid: the 4x4x4 steps

  1. Sit the person upright and stay calm and reassuring.
  2. Give 4 puffs of a blue/grey reliever (such as salbutamol). Use a spacer if available — one puff at a time, taking 4 breaths after each puff.
  3. Wait 4 minutes. If there is no improvement, give 4 more puffs the same way.
  4. If there is still no improvement, call 000 and say it is an asthma emergency. Keep giving 4 puffs every 4 minutes until the ambulance arrives.
Call 000 immediately if the attack is severe, the person is not improving, the reliever is not helping, or you are unsure — and keep giving reliever puffs while you wait.

If it’s a first attack or there’s no reliever

If someone appears to be having a first-ever asthma attack, or no reliever is available, call 000 straight away. If you can find any blue/grey reliever puffer (even someone else’s), it is safe to use it following the 4×4×4 steps while waiting for help.

Asthma First Aid FAQs

What is the 4x4x4 rule for asthma?

Give 4 puffs of a blue/grey reliever (one puff at a time, 4 breaths after each), wait 4 minutes, then give 4 more puffs if there is no improvement. If still no improvement, call 000 and keep giving 4 puffs every 4 minutes.

What do you do in an asthma attack?

Sit the person upright, stay calm, and follow the 4x4x4 reliever steps. Call 000 if the attack is severe, not improving, or you are unsure — and keep giving reliever puffs until help arrives.

Can you use someone else's reliever puffer?

Yes — in an emergency it is safe to use any blue/grey reliever puffer to help someone having an asthma attack. Reliever medication will not harm them even if it turns out not to be asthma.

When should you call an ambulance for asthma?

Call 000 if the attack is severe, the reliever is not helping, the person cannot speak or has blue lips, it is a first attack, or you are unsure. Keep giving reliever puffs while you wait.

Be prepared for breathing emergencies. Keep a stocked first aid kit, and for workplaces and clinics see first aid room equipment. Follow the DRSABCD action plan if the person becomes unresponsive. Fast shipping Australia-wide.

Source: Asthma Australia — Asthma First Aid. In an emergency, call 000.

Published: July 03, 2026