ASTHMA ATTACK
Definition
- Child is having an asthma attack.
- Don't use this guideline unless your child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician.
Main Symptoms
- A wheeze or whistling (purring) sound on breathing out is the classic symptom.
- Coughing may be the first symptom of an asthma attack.
Causes (Triggers) of Asthma Attacks
- Viral respiratory infections
- Animal contact (especially cats)
- Tobacco smoke
- Pollens
- Air pollution (e.g., barn, circus, wood stove, dirty basement).
See More Appropriate Topic (instead of this one) If
- No previous asthma diagnosis or use of asthma medicines, see WHEEZING.
WHEN TO CALL YOUR DOCTOR FOR ASTHMA ATTACK
Call 911 Now (your child may need an ambulance)
- Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath).
- Your child passed out or has bluish lips/tongue.
- Wheezing started suddenly after medicine, an allergic food or bee sting.
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick.
- Looks like he did when hospitalized before with asthma.
- Difficulty breathing not resolved 20 minutes after neb or inhaler.
- Peak flow rate lower than 50% of baseline level (personal best) (RED zone).
- Peak flow rate 50-80% of baseline level after using neb or inhaler (Yellow zone.
- Wheezing (heard across the room) not resolved 20 minutes after using neb or inhaler.
- Continuous (nonstop) coughing that keeps from playing or sleeping and not improved after using neb or inhaler.
- Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours.
- Fever above 105°F (40.6°C).
- Severe chest pain.
Call Your Doctor Within 24 Hours (between 9am and 4pm) If
- You think your child needs to be seen.
- Sinus pain (not just congestion).
- Fever present for more than 3 days.
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns.
- Don't have written asthma action plan
- Missing more than 1 day of school/month for asthma.
- Asthma limits exercise or sports.
- Asthma attacks frequently awaken from sleep.
- Uses more than 1 inhaler/month.
- Mild wheezing persists for more than 5 days.
- No asthma check-up in over 1 year.
Parent Care at Home If
- Mild asthma attack and you don't think your child needs to be seen.
HOME CARE ADVICE FOR ASTHMA ATTACK
- Asthma Rescue Medicine:
- Start your child's quick relief medicine (e.g., albuterol inhaler or nebs) at the first sign of any coughing or shortness of breath (don't wait for wheezing). (Reason: Early treatment shortens the asthma attack).
- The best "cough medicine" for a child with asthma is always the asthma medicine.
- Follow your child's action plan for asthma attacks.
- For albuterol inhalers, give 2 puffs separated by a few minutes, every 4 to 6 hours.
- Continue the asthma rescue medicine until your child has not wheezed or coughed for 48 hours.
- Asthma Controller Medicine: If your child is using a controller medicine (eg inhaled steroids or cromolyn), continue to give it as directed.
- Hay Fever: For nose allergy symptoms, it's OK to give antihistamines.
- Fluids: Encourage drinking normal amounts of clear fluids (e.g.,water) (Reason: keeps the lung mucus from becoming sticky).
- Humidifier: If the air is dry, use a humidifier (reason: to prevent drying of the upper airway).
- Avoid or Remove Allergens: Give a shower to remove pollens, animal dander, or other allergens from the body and hair. Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows, exercise).
- Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
- Call Your Doctor If:
- Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours
- Wheezing is not completely cleared by 5 days
- Your child becomes worse
And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
REFERENCES
- Alario AJ, Mansell A, Mansell C: Management of acute asthma in the pediatric office. Pediatr Ann 1999;28:19-28.
- Delgado A, Chou KJ, Silver EJ, Crain EF. Nebulizers vs. metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003;157:76-80.
- Gayle MO and Kissoon N. Assessment of respiratory distress in the asthmatic child: When should we be concerned? Pediatr Ann. 1996;25:128-134.
- Guill MF. Asthma update: clinical aspects and management. Pediatr Rev. 2004;25(10):335-343.
- Lasley MV. New treatments for asthma. Pediatr Rev. 2003;24(7):222-232.
- Morris A, Mellis C. Asthma. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health. London, England: BMJ Publishing Group; 2000. p. 206-214
- NAEPP Expert Panel Report. Guidelines for the diagnosis and management of asthma, Washington, DC, 1997, 2002.
- Richman MJ, Scott P, Kornberg A. Partnership for excellence in asthma care: Evidence-based disease management. Pediatr Ann. 1998;27:563-568.
- Sherman FM and Capen CL. Red alert program for life-threatening asthma. Pediatrics. 1997;100:187-191.
- Turcios NL. What you need to know about pediatric asthma pharmacology. Contemp Pediatr. 2001;18(1):81-101.
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
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