Pediatric Asthma

• Asthma is often seen in children. It is a leading cause of missed school

days and hospital visits for children.
• Most common serious chronic disease children
• May be intermittent, with symptom-free periods, or chronic, with
continuous symptoms

Causes
• Inherited traits
• Some types of airway infections at a very young age
• Exposure to environmental factors, such as cigarette smoke or other
air pollution
• Irritating odors like turpentine or smog
• Weather changes or cold air
• Hypersensitivity to allergens
• Allergies to house dust, pet dander, pollen or mold, or peanuts
• Aspirin can be a trigger

Mechanism of Disease
• The process of bronchospasm, inflammation of bronchial mucosa, and
increased bronchial secretion act together to reduce the size of the
airway lumen.

Complications
• Severe asthma attacks that require emergency treatment or hospital
care
• Permanent narrowing of the airways (bronchial tubes)
• Missed school days or getting behind in school
• Poor sleep and fatigue
• Symptoms that interfere with play, sports or other activities

Assessment
• Derived from the Greek word for “panting”
• Starts with dry cough
• Develop increasing difficulty exhaling
• Typical dyspnea and wheezing

History
• Assessment should include a thorough history of the development of a
child’s symptoms; for example, what the child was doing at the time of
the attack, and what actions were taken by the parents or child to
decrease or arrest the symptoms.
• Physical assessment
• Initial wheezing is only heard through stethoscope auscultation
 • Wheezing is generally audible in all lung fields
• Central cyanosis
• Elevated count of eosinophil
• A bronchospasm leads CO2 trapping and retention; therefore, arterial
oxygen saturation monitored by a pulse oximeter will begin to
decrease because of the child’s inability to fully aerate the lungs.
• Air-filled lungs are hyperresonant to percuss.
• Expiration phase is longer than inspiration phase.
• Time both phases
• Observe for retractions
• As constriction becomes acute, wheezing decreases
• Hypoxia and cyanosis become severe
• If PCO2 level increases and wheezing stops, respiratory failure is
imminent
• Comfortable position: sitting or standing
• If seated in a chair, they lean forward and raise their shoulders for
maximum breathing.
• Over time, shield-like or barrel-shaped chest is evident.
• Clubbing of the fingers is noticeable
• For children with longer use of steroids, they are shorter than usual.

Peak expiratory flow rate monitoring:

• The green zone (80%-100% of their personal best) means no asthma
symptoms are present, and they should take their routine medications.
• The yellow zone (50%-80% of personal best) signals caution. An
episode of asthma may be beginning.
• The red zone (below 50% of personal best) indicates an asthma
episode is beginning.

Therapeutic management
• Three goals for allergic disorders:
1. Avoidance of the allergen by environmental control
2. Skin testing and hyposensitization to identified allergens
3. Relief of symptoms by pharmacologic agents
• Cough suppressants are contraindicated with asthma, as a rule, as
long as children can continue to cough up mucus, they are not in
serious danger.
• A child with mild but persistent asthma usually is prescribed an inhaled
anti-inflammatory corticosteroid such as fluticasone either daily or
every other day (not taking the steroid everyday may allow for more
growth).
• Children who have moderate persistent symptoms usually are
prescribed a long-acting bronchodilator at bedtime in addition to the
anti-inflammatory corticosteroid.
 • Children who have severe persistent asthma symptoms may take a
high dose of both an oral corticosteroid and an inhaled corticosteroid
daily as well as a long-acting bronchodilator at bedtime.
• If children are to receive medication by nebulizer or inhaler, be certain
they know how to use these properly.
• Encourage children to continue to drink fluids; although milk and milk
products should be avoided because they cause thick mucus and
difficulty swallowing.

Diagnosis:
• Ineffective airway clearance related to excessive mucus production
• Ineffective breathing pattern related to difficulty of breathing
• Fear related to sudden onset of asthma attack
• Health-seeking behaviors related to prevention of and treatment for
asthma attacks

Status asthmaticus
• When children fail to respond and an attack continues.
• Extreme emergency
• Child may die of heart failure caused by the combination of
exhaustion, atelectasis, and respiratory acidosis from bronchial
plugging.

Assessment
• Have acute respiratory distress
• Elevated heart rate and respiratory rate
• Decreased O2 saturation and PO2
• Increased PCO2 leading to acidosis
• Breath sounds limited
• Initiated by a respiratory infection
• Obtain cultures from deep coughed sputum and prepare to administer
a broad-spectrum antibiotic
Therapeutic management
• Continuous nebulization with Beta-2 agonist and intravenous
corticosteriods
• Give oxygen by face mask or nasal prongs at more than 90 mmHg for
30%- 40% concentration
• If more than 40%, a Venturi mask that allows for rebreathing may be
used
• Increase fluid through intravenous infusion since drinking aggravate
coughing
• Monitor intake and output
• Endotracheal intubation and mechanical ventilation may be necessary
to maintain effective respiration