During an asthma attack the airways get narrower, in particular in the bronchia. Because the muscles around the airways cramp up and the mucous membrane in the airways gets inflamed, more mucus is produced. An asthma attack can have various triggers: allergic reactions, overstraining and stress or excessive exertion, for example. STEP 1: TYPICAL SYMPTOMS An asthma attack is recognizable through wheezing noises, respiratory distress and throat irritation, and may be accompanied by the coughing up of thick mucus. Anxiety, uneasiness, a characteristic posture, and blue skin and lips occur too. The symptoms of shock can even lead to disorientation and loss of consciousness. Not all of these symptoms have to occur, and not all at the same time. STEP 2: PSYCHOLOGICAL SUPPORT As a first responder, it is above all important to keep calm and not let the anxiety and hectic rush of the situation have an impact upon the patient. While helping the patient to find their medication, you should interact with them in a calming way and use soothing words. STEP 3: HELPING SOMEONE TO TAKE THEIR PERSONAL MEDICATION The asthma inhaler should be administered as soon as possible. The patient does this themselves. A first responder may help if the patient no longer has the strength or coordination. It’s important that this happens under instruction. A first responder may not administer emergency medication on their own! STEP 4: EMERGENCY CALL YES OR NO? The difficulty breathing normally improves after taking the emergency medication. The group should then discuss whether it’s possible to continue with the tour, or whether to abseil back down. STEP 5: NO PERSONAL MEDICATION TO HAND If the patient does not have any emergency medication with them or isn’t familiar with this reaction, an emergency call must be made immediately and you should wait for the emergency services together. If the patient becomes unconscious, put them in the stable recovery position if they are still breathing. If they are not breathing, begin resuscitation immediately.