Asthma Attack

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 or menthol vapors
  • 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 104°F (40°C) and not improved after 2 hours of fever medicine.
  • Severe chest pain.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

  • You think your child needs to be seen.
  • Mild wheezing persists over 24 hours on treatment.
  • 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.
  • 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

  1. 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.
  2. Asthma Controller Medicine: If your child is using a controller medicine (eg inhaled steroids or cromolyn), continue to give it as directed.
  3. Hay Fever: For nose allergy symptoms, it's OK to give antihistamines.
  4. Fluids: Encourage drinking normal amounts of clear fluids (e.g.,water) (Reason: keeps the lung mucus from becoming sticky).
  5. Humidifier: If the air is dry, use a humidifier (reason: to prevent drying of the upper airway).
  6. 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).
  7. Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
  8. Call Your Doctor If:
    • Difficuly breathing occurs
    • 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

  1. Alario AJ, Mansell A, Mansell C: Management of acute asthma in the pediatric office. Pediatr Ann 1999;28:19-28.
  2. 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.
  3. Gayle MO and Kissoon N. Assessment of respiratory distress in the asthmatic child: When should we be concerned? Pediatr Ann. 1996;25:128-134.
  4. Guill MF. Asthma update: clinical aspects and management. Pediatr Rev. 2004;25(10):335-343.
  5. Lasley MV. New treatments for asthma. Pediatr Rev. 2003;24(7):222-232.
  6. 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
  7. NAEPP Expert Panel Report 3. Guidelines for the diagnosis and management of asthma, Washington, DC, August 2007.
  8. Richman MJ, Scott P, Kornberg A. Partnership for excellence in asthma care: Evidence-based disease management. Pediatr Ann. 1998;27:563-568.
  9. Sherman FM and Capen CL. Red alert program for life-threatening asthma. Pediatrics. 1997;100:187-191.
  10. 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.

See Other Topics:

View Anatomic Index of Topics


This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.