Asthma and the ‘Paper Bag’ technique

Breathing deeply into a paper bag is a technique widely-recognised as a response to panic attacks.

Panic attacks account for some 25% of all cases of hyperventilation. And hyperventilation — like asthma — causes breathing difficulties and tightness in the chest.

Can the same paper bag technique be used for an asthma attack?

The answer is ‘No’.

In fact, the Australian Resuscitation Council (ARC) guidelines warn against using any bag for rebreathing, explaining that the technique may be dangerous and should only be used under medical direction.

Let’s investigate the practice and understand why the paper bag technique is no replacement for an asthma inhaler. We’ll also reveal how to do proper first aid for an asthmatic when a puffer is not available.



What is the Paper Bag technique?

The paper bag technique got its reputation for being one way to control hyperventilation.

Hyperventilation is another word for over-breathing. Carbon dioxide is exhaled too quickly and too much oxygen enters the lungs, causing an imbalance of the two in the bloodstream.

Breathing into a paper bag involves re-breathing exhaled air, which is more carbon dioxide rich and therefore expected to boost CO2 in the blood. But, as mentioned previously, breathing into a bag is not recommended.

If you feel like you’re hyperventilating, your doctor would more likely advise breathing techniques and possibly prescribe medications.

What happens in a panic attack?


A panic attack is an intense episode of anxiety. The physical sensations can include trembling, shortness of breath, heart racing, dizziness, and muscle tension.

Panic attacks can last a few minutes, or up to half an hour. They are not uncommon. Around 35% of the population will experience a panic attack during their lifetime.

Rapid breathing in a panic attack results in exhalations prevailing over inhalations and diminished levels of carbon dioxide. This hyperventilating means the body will end up with more oxygen than it needs, causing respiratory alkalosis (high pH).

Potassium, phosphate and calcium levels drop, and undesirable side effects occur, including numbness and tingling in fingers, toes, lips, and other extremities; muscle cramp; constriction of blood vessels; abnormal heart rhythms and low blood pressure. Other symptoms can include chest pain, confusion, dizziness, dry mouth, and weakness.

It can also lead to the person feeling short of breath, causing them to breathe even faster, and making the problem worse.

The premise of the paper bag technique is that re-breathing the exhaled carbon dioxide (CO2) would return normal pH levels to the body, helping to allay the feeling of being short of breath and encourage normal breathing again.

Paper bag for asthma?

It’s entirely possible for a person to believe they are having a panic attack when they are actually experiencing an asthma attack, or a diabetic or cardiac problem. Breathing more CO2 would make these problem worse.

For reasons outlined below, the paper bag technique is not even a close substitute for an asthmatic’s inhaler and prescribed medication.

Asthma attack vs. Panic attack: Know the difference

Despite sharing some similar symptoms, an asthma attack and a panic attack are very different. Their treatments are not interchangeable.

A person having a panic attack struggles to breathe, just like an asthmatic. The problem for them is a lack of carbon dioxide.

For an asthmatic, the problem is airway obstruction. The asthmatic will cough, wheeze, and breathe in a laboured manner because their airways are inflamed and burdened by mucus.

An inhaler allows the asthmatic to breathe in corticosteroids or cortisone-like medicines. A paper bag, clearly offers none of that.

When inhaled, the asthma medicines counter-act inflammation in the airways, decrease mucus production, and relieve discomfort in the chest.

The tell-tale symptom that differentiates hyperventilation from asthma is over-breathing.

If over-breathing is not the case, but breathing — even a little — is a struggle, it’s time to initiate first aid for asthma.

Asthma attacks

Asthma is a respiratory condition that afflicts 2.7 million people in Australia — one in 9 of us (Australian Bureau of Statistics, 2018). And it’s a statistic that is not in decline.

The gravity of this hits home when this statistic is you, a family member, a friend, a co-worker, or a neighbour. 

Most asthmatics know to always carry their puffer, their medication, and a copy of their asthma action plan. However, there is always going to be a time…

Breathe in, breathe out, and read on for important tips about how to help when an asthma attack happens and neither a puffer, medication, or an asthma action plan are at hand.

6 preliminary steps for treating asthma

First aid treatment provides relief to the victim of an asthma attack.

In the absence of the victim’s puffer, medications, and asthma action plan, here are 6 steps you can take to initiate their recovery.

        1. Help the person sit upright. Avoid bent over or prone positions as these would constrict their breathing even more.
        2. Guide the person to take long, deep breaths. Encourage them to inhale deeply through their nose and to exhale just as deeply from their mouth.
        3. Calm the person. Comfort them in a gentle manner and assure them they will get through this. Not only will this offer some emotional relief, staying calm will help prevent them further tightening their chest muscles, thereby making breathing easier.
        4. Distance them from potential triggers. Triggers for an asthma attack could include dust, pollen, cigarette smoke and animal dander. If such triggers are present, carefully move the victim to a cleaner, cooler room with better air circulation.
        5. Offer them a hot caffeinated beverage. A lesser-known treatment for asthma, but a sip of a hot caffeinated drink, such as coffee, might help open the person’s airways.
        6. Don’t hesitate to call for additional help if the previous 5 steps fail to provide relief and the person is unable to get their hands on their inhaler or meds. Immediately call Triple Zero (000) for help.

Our DRSABCD article is a must-read for anyone dealing with a life-threatening medical emergency

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