Empecé con síntomas de asma de adulto y

Sit them upright, use only their own prescribed reliever with their own spacer exactly as you were trained, and spend the next 25 minutes making the technique right — and know these four signs, because any one of them means you stop and call your local emergency number now: they cannot finish a sentence, their lips or nails are blue or grey, their ribs or neck are pulling in with every breath, or the noisy wheezing has gone quiet while they still feel unwell.

I cannot look up your local emergency number from where I sit, because I do not know your city or country — so use the emergency number your area uses for ambulance; tell me your city or country in a message and I will confirm the right one for you. This is home guidance, not a diagnosis, and not a substitute for their clinician or their written asthma action plan.

Spacer vs nebulizer: the honest answer

A spacer is not a weaker copy of a nebulizer. With the inhaler used correctly through a spacer, the medicine reaches the lung as a fine mist the same way nebulized medicine does — for many people, especially children, it works at least as well for a flare, and at home it is faster, cheaper and easier than setting up a machine and tubing.

Where the nebulizer genuinely wins: a very young child who cannot seal a mouthpiece and needs a good mask seal, someone too breathless to coordinate a breath, and a small number of people whose prescriber has deliberately written nebulized reliever into their plan.

So the device question is settled by their written action plan and their prescriber, not in the kitchen tonight. Do not swap devices, do not add a nebulizer, and do not improvise one. What you *can* fix tonight, for free, is the single most common reason a spacer "does not work": wrong technique.

Technique checklist (each step is from their own plan, nothing added): sit or stand tall; shake the inhaler and empty the air; put the mouthpiece or mask in the mouth and close the lips around it, or get the mask seal with no gap; press once; then breathe in slowly and deeply — several calm breaths, not one gasp; keep the spacer in place while they breathe in; rinse the spacer with clean water and air-dry it, never a cloth.

1. What you already have, and the safer ways to use it

Already in place: their own prescribed inhaler, their own spacer, a calm kitchen table, and someone free to help. That is a good starting point.

If nobody is unwell right now, treat tonight as rehearsal: run the technique checklist twice, timed, and let the child (or the person) describe each step back to you.

Tonight, in roughly 25 minutes

Safe, free things that help: sitting upright (leaning slightly forward is fine); staying calm and nearby; a quiet room and cool, clean air; small sips of water; a written timeline of what happened and when; keeping the reliever and spacer where everyone can reach them.

2. Constraints and the avoid-list

• Do not use anyone else's inhaler, and never an oxygen cylinder or concentrator you borrowed.
• Do not add extra doses, shorten the gaps, or change the timing beyond what their written plan already says.
• Do not stop a daily preventer because they "seemed fine this week".
• Do not use leftover antibiotics or steroid tablets from an old flare.
• Do not buy inhalers, spacers or "breathing powders" online, and do not build a homemade spacer or a nebulizer recipe.
• Do not lay them flat; do not send them to bed to see how it goes.
• Do not judge safety by how loud the wheezing is — a quiet chest in someone still unwell is worse, not better.
• Do not use a home oxygen reading as the reason to delay getting help.
• Do not send a child to school or send an adult out alone while breathing is still laboured.

3. Red flags: when to leave home care and get help

Call your local emergency number now if any of these are present:

• they cannot speak in full sentences
• blue or grey lips or nail beds
• ribs, neck or shoulders pulling in with each breath
• exhaustion, drowsiness, confusion, or drifting off mid-sentence
• the chest has gone quiet while they still feel unwell
• their own reliever, used as prescribed, has not settled the breathing within 15–20 minutes
• symptoms come back again within a couple of hours, or they need their reliever more often than their plan allows

While help is on the way: sit them upright and stay with them; keep them calm; use only their own prescribed reliever with their own spacer, as trained; have the inhalers, spacer, action plan and medicines list ready; note the start time, what was used and when, and what changed.

See the clinician soon (not tonight) if: their inhaler technique has never been checked; they are waking at night with symptoms; they needed the reliever more than usual this month; the school needs a written plan; the spacer does not fit well (mask leaks, mouthpiece too big, they cannot seal it).

Decision tree

```
Is anyone in the house struggling to breathe right now?
├─ No → Run the 25-minute plan above. Book a technique check.
└─ Yes → Sit them upright. Use ONLY their own reliever + their own spacer, as trained.
├─ Any red flag present (sentence / colour / ribs / quiet chest / drowsy)?
│ └─ Yes → Call your local emergency number now. Stay with them, keep the bag by the door.
└─ No red flag → Wait 15–20 minutes and watch the four checks:
├─ Speaking in full sentences again, colour normal, ribs quiet, alert
│ └─ Keep watching tonight. If it returns within a couple of hours → clinic or emergency number.
└─ Any check fails → Call your local emergency number now.
```

Scripts you can send as they are

To the other adult in the house: "X is having an asthma flare. The reliever and spacer are on the table. Please sit them upright and stay with them — no smoking, no cooking fumes. If they cannot finish a sentence, or the breathing goes quiet, we call the ambulance."

To school or nursery: "X has asthma and is using their own reliever with a spacer. Their breathing was [settled / not settled] after their reliever today. Please send them with their inhaler and spacer, and call us if they need it more than usual."

To the clinic: "X has asthma. Using their own reliever with a spacer at home as prescribed. Breathing after the reliever: [settled within about 15 minutes / still laboured]. They can/cannot speak in full sentences, colour normal, ribs not pulling in. We would like an inhaler technique check and a written action plan."

To the ambulance dispatcher: "Known asthma, worsening breathlessness since [time]. Using their own reliever with a spacer at [time] as prescribed. [Cannot speak in full sentences / lips blue / ribs pulling in / chest quiet and drowsy]. Allergies: [ ]. Medicines: [ ]. Inhalers and spacer coming with us."

What a good next 24 hours looks like

• They can speak in full sentences again, and their colour is normal.
• They are alert and up, not drifting off.
• Breathing is quiet for them, with no ribs pulling in.
• They are back to their usual sleep and usual activity, not propped up and awake at 3 a.m.
• The reliever is used only as their written plan says — not more often.
• The spacer and technique were checked by an adult, and the action plan is in the bag by the door.

That is a realistic good night and a good next day. It is not a cure, and it does not replace their action plan — but with the technique right, the right device, and the red flags caught early, most flares at home stay at home.

Bring to any appointment or emergency visit: every inhaler and the spacer (and the preventer), the written action plan, the medicines list and allergies, and the timeline — when it started, what was used and when, what improved, what did not.

Source: who-core https://www.who.int/news-room/fact-sheets/detail/asthma
Source: rch-cpg https://www.rch.org.au/clinicalguide/guideline_index/Acute_asthma/
Source: merck-pro https://www.merckmanuals.com/professional/pulmonary-disorders/asthma-and-related-disorders/asthma