- Asthma is a chronic inflammatory disease of the airways.
- Asthma is classified based on disease severity; management includes medications, environmental control of allergens, and child and family education.
- The allergic reaction in the airways caused by the precipitant can result in an immediate reaction with obstruction occurring, and it can result in a late bronchial obstructive reaction several hours after the initial exposure to the precipitant.
- Mast cell release of histamine leads to a bronchoconstrictive process, bronchospasm, and obstruction.
- Diagnosis is made based on the child’s symptoms, history and physical examination, chest radiograph, and laboratory tests.
- Precipitants may trigger an asthma attack.
- Status asthmaticus is an acute asthma attack, and the child displays respiratory distress despite vigorous treatment measures; this is a medical emergency that can result in respiratory failure and death if not treated.
- Child has episodes of dyspnea, wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning or both.
Acute asthma attacks
- Episodes include progressively worsening shortness of breath, cough,wheezing, chest tightness, decreases in expiratory airflow secondary to bronchospasm, mucosal edema, and mucus plugging; air is trapped behind occluded or narrow airways, and hypoxemia can occur.
- The attack begins with irritability, restlessness, headache, feeling tired, or chest tightness; just before the attack, the child may present with itching localized at the front of the neck or over the upper part of the back.
- Respiratory symptoms include a hacking, irritable, nonproductive cough caused by bronchial edema.
- Quick-relief medications (rescue medications):
- Used to treat symptoms and exacerbations.
- Long-term control medications (preventer medications): Used to achieve and maintain control of inflammation.
- Nebulizer, metered-dose inhaler (MDI): May be used to administer medications; if the child has difficulty using the MDI, medication can be administered by nebulization (medication is mixed with saline and then nebulized with compressed air by a machine).
- If the MDI is used to administer a corticosteroid, a spacer should be used to prevent yeast infections in the child’s mouth.
- The child’s growth patterns need to be monitored when corticosteroids are prescribed.