The 4:4:4 rule every parent should know: “You can save a life”

Posted in Family Health.
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Even though asthma is a fairly common condition that affects 1 in every 9 Australians, it doesn’t make it any easier for parents to watch their little one struggle to breathe.



World Asthma Day

Today is World Asthma Day, and St John Ambulance service is working towards a global initiative to improve awareness of the condition and to educate people on how to respond to an asthma attack.

Sarah Lance is the CEO of St John Ambulance NSW. She says education is the key to reducing asthma-attributed deaths in Australia.

“We need to encourage people to learn what do to help someone suffering an asthma emergency. If we all know how to help, we can reduce the number of unnecessary deaths from this condition.”

Asthma signs and symptoms

Common symptoms of asthma include:

  • shortness of breath
  • tightness in the chest
  • wheezing
  • coughing – especially at night

Asthma is different for everyone and although these symptoms are common, they aren’t all necessary for an asthma diagnosis. Other signs and symptoms include becoming pale and sweating, blueness around lips, ear toes or fingertips and, understandably, an increase in panic and anxiety.

If your child is undiagnosed but shows some symptoms, it is important to take them to your GP to discuss putting in place an Asthma Action Plan, which should be given to all care providers and kept somewhere easily acceptable.

Unfortunately, there is no cure for asthma, but it can be managed by avoiding triggers and with the use of appropriate medications including relievers, preventers and controllers.

The 4:4:4 rule

The most important thing to know is the 4:4:4 rule, which involves doing the following: 

  • Ensure they are sitting upright and leaning forward
  • Give four puffs, one at a time, of a blue reliever inhaler (and use a spacer)
  • Wait four minutes
  • If no improvement, give another four puffs.

If there is little to no improvement and the child still cannot breathe normally, call 000 and inform them that the child is having an asthma attack and continue administering the 4:4:4 rule on the child until an ambulance arrives. Try to stay calm and reassure the child.

“You can save a life”

Sarah says, “You can go to the St John NSW website where you can find a great fact sheet on helping a person during an asthma attack. It is a quick read and can help you to save a life.

“While asthma is a global killer, you can save a life with first aid knowledge.”

For more information, or to download the fact sheet, visit the website

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