About 8 percent of American kids have asthma. In youth sports, that means at least one or two on every team. Most attacks on the field are mild and resolve with the rescue inhaler. Some are not. The protocol below distinguishes the two.
The signs. Coughing that does not stop. Wheezing on exhale, often audible without a stethoscope. Chest tightness or “I can’t catch my breath.” Shoulders hunched, leaning forward. Speaking in short phrases or single words. Lips or fingertips turning blue (this is severe).
The kid with asthma usually knows. The first thing to do is ask: “Is this an asthma thing?” The kid says yes, you act on it. Trust the kid.
The Asthma Action Plan. Every kid with diagnosed asthma should have a written Asthma Action Plan from their pediatrician or allergist. The plan uses a green-yellow-red zone format and tells the family and the team exactly what to do at each level. The plan should be on file with the team manager or coach.
If your kid has asthma and there is no Action Plan on file, that is the homework before the next practice.
Green zone (the well kid). Pre-game and pre-practice management. The plan may include a pre-exercise inhaler dose 15 minutes before activity. Many kids with exercise-induced asthma do this and never have an attack.
Yellow zone (the early attack). The kid is symptomatic but talking in full sentences and not severely distressed. The protocol:
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Stop the activity. The kid sits or stands in a comfortable position, leaning slightly forward.
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Use the rescue inhaler (typically albuterol) per the Action Plan. Standard is two puffs, with a spacer if available. Wait one minute between puffs.
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Wait 5 to 10 minutes. Symptoms usually improve.
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If symptoms resolve, the kid may be able to return to activity at lower intensity per the plan. If not, done for the day.
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Notify the parent and recommend a pediatrician check.
Red zone (the severe attack). Any of the following: lips or fingertips blue, struggling to speak, ribs visibly retracting with each breath, no improvement after the rescue inhaler, drowsiness or confusion. The protocol:
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Call 911.
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Continue rescue inhaler doses every 20 minutes per the Action Plan or per medical direction.
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Keep the kid sitting up, leaning forward.
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Stay with the kid. Do not leave them alone.
A red-zone attack is a life-threatening event. Cardiac arrest can follow severe asthma. Time to EMS matters.
Spacers and proper technique. Most kids do not use rescue inhalers correctly. The medication ends up in the back of the throat instead of the lungs. A spacer (a plastic chamber that attaches to the inhaler) doubles the lung delivery in pediatric users per pulmonology research.
Every kid with asthma should have a spacer, and should practice using it under non-emergency conditions so the technique is automatic during the attack.
Cold-air practice. Cold dry air narrows airways. Asthmatic kids should pre-medicate per their plan and warm up longer in cold conditions. A scarf or buff over the nose and mouth pre-warms the air before it reaches the lungs.
For coaches. Three things to know.
Which kids on your roster have diagnosed asthma. The roster master in the safety bag should list this.
Where each asthmatic kid’s rescue inhaler lives. In the team bag, the kid’s gear bag, or somewhere accessible.
When to call 911 versus when to wait. The Action Plan tells you. If the symptoms match red-zone signs and there is no Action Plan on file, default to calling 911.
For parents. Your kid’s inhaler should be checked once a month. Albuterol expires; a kid using a 2024 inhaler in 2026 may not be getting full dosing. The expiration date is on the canister.
The honest read. Asthma deaths in youth athletes are nearly always preventable with the Action Plan, an in-date inhaler, a spacer, and an adult on the field who knows the protocol. The team that has these set up before the season is a team where asthma is managed, not a crisis.
If this content is reaching someone whose kid is currently in an attack, call 911 and use the rescue inhaler immediately.