Asthma Emergencies quick relief guidelines
Asthma emergencies Since three-year-old Robert was diagnosed with asthma a year ago, his symptoms and flares have been minor and easily treated with albuterol. But late one evening, as they were putting him to bed, his parents noticed a change in his breathing. Something was just different.”He seemed to be working harder to breathe. Robert had come down with a cold earlier in the week, and his chronic cough grew worse.When his dad went to check on him at 2 A. m , Robert was sitting up straight, and the muscles in his neck and chest were moving visibly with each breath. He was able to get out only a few words at a time. While Dad gave him an albuterol treatment, his mother counted his breathing rate at forty times per minute. Dad called the family doctor who recommended going immediately to the Asthma emergencies room.
Asthma emergencies in most of this article has focused on the importance of controlling asthma-related symptoms that affect your child on a day-to-day basis. That focus is appropriate because asthma is a chronic illness, and the long-term effect of these symptoms may have a profound impact on a child’s quality of life at home and school. This chapter, however, will examine a much more dramatic face of the disease the Asthma emergencies that every parent fears as we follow Robert through his trip to the emergency room. Asthma Symptom flares can occur in any child with asthma and, if not managed successfully, can result in an unexpected trip to an emergency department. This chapter addresses how to recognize and manage severe flares of asthma and gives an overview of emergency and hospital care for Asthma emergencies. If you understand this information in advance and review it from time to time, any emergency can be handled more successfully and with less distress for you and your child.
Who Is At Risk for Asthma Emergencies?
Asthma emergencies visits, hospitalizations, and even deaths from asthma have all increased over recent decades, and the causes are not entirely cleat A major driving force is certainly the increase in overall asthma rates, which more than doubled from about 3 percent of American children in the 1980s to 7 percent today. But other factors also come into play: children from low socioeconomic backgrounds are more likely to be hospitalized for asthma emergencies and asthma care, possibly reflecting a lack of access to optimal medical care. Signs of poor asthma control, such as past severe flares and frequent albuterol use, have been linked to an increased risk of death from asthma.
The link between poor control and poor outcome suggests some good news about reducing the risk. Studies have shown marked reductions in asthma emergencies visits, hospitalizations, and mortality rates when asthma is brought under control with effective treatment. During the 1990s, great effort was devoted to developing new therapies and improving standards of care for asthma. These attempts appear to have had some success, as the most recent statistics show a leveling off in asthma hospitalizations nationwide. When a child’s asthma is under good control and the child is otherwise healthy, there’s no need for anxiety about an asthma emergencies lurking around the next corner Children with asthma should be able to travel, go camping, and do all of the other things that are a normal part of growing up. With an appropriate management plan, most asthma flares can be managed without a visit to a hospital. When troubles arise, however, a healthy respect for asthma is appropriate. An important part of any plan is a recognition that things may not go as expected, so rapid, immediate care may be necessary.
WHEN IS ASTHMA AN EMERGENCY?
Warning signs of a severe asthma flare vary for individual children will cause for Asthma emergencies. As you know, flares occur when a trigger increases inflammation in the airways of the lung. Research suggests that common colds and flu viruses trigger the great majority of severe flares, although conditions in the environment (such as smoke and allergens) can also be important triggers. Airway inflammation leads to increased mucus production and contraction of the muscles in the airway wall (bronchospasm). When the airways in the lung narrow, more work is needed to push out waste gases, such as carbon dioxide. The body’s normal response to this airway obstruction is to increase its effort to breathe by using muscles between the ribs and in the neck, which may become more noticeable than usual, as Robert’s parents observed in the middle of the night.
The chest and belly may move in opposite directions like a seesaw as muscles below the diaphragm help to move air up and out of the lungs. A child may stop doing other activities and sit up straight to focus on breathing. His rate of breathing will increase. He may become short of breath and able to speak only a few words at a time. Normal breathing rates vary by age and are displayed on the next page. Signs like these indicate an important change in the child’s condition and require immediate treatment with a quick-relief medicine such as albuterol. If these signs continue, it’s time to begin the flare part of your management plan and call your doctor or nurse practitioner. If symptoms get worse despite this treatment, go to an emergency department.
With most children, particularly infants and toddlers, you can easily observe signs of severe airway obstruction. But other problems can occasionally mimic an asthma flare. In young infants, for example, a nose blocked with mucus can mimic wheezing. Clearing the nose with a suction bulb should resolve the breathing trouble. On the other hand, some children adjust to chronic obstruction of their airways and show few signs even when their condition becomes worse. This usually happens in children with a long history of poorly controlled asthma. For these children, obtaining an objective measurement of lung function by using a peak flow meter can be very helpful. A reduction in peak flow to less than 80 percent of a child’s usual best measurement indicates moderate obstruction that should be treated with a quick-relief medicine such as albuterol. A reduction in peak flow to 50 percent of the child’s usual best should be considered a severe obstruction that requires immediate evaluation.