ASTHMA

Chronic inflammatory disorder of the airway characterized by

recurring symptoms, airway obstruction and bronchial
hyperresponsiveness

 RAD = set of symptoms and not a formal diagnosis 

most kids are not dx with asthma younger  doctors call
condition reactive airway disorder

Etiology & Triggers

 Environmental exposures
o Pollen, grass etc
 Viral illnesses
 Allergens
 Genetic predispositions
 Kids have several usually have illness such as
eczema and allergies
 Exercise
 Cold air
Incidence
 One of the most common chronic among children
and top reasons for readmission
 See admission go up during certain times of year

Risk Factor
 Genetic predisposition
 Airway issues with infant
 Family history
  Boys effected more
 Exposure to tobacco smoke
 Low birth weight, being overweight

Pathophysiology
 Trigger is resent  actives igE 
 Release of inflammatory mediators
o Histamines, prostaglandin, leukotrienes
 Inflammatory mediator initiates:
o Bronchospasms, vascular congestion, increased
vascular permeability, edema formation, mucous
production and thickening of the airway walls
 Your body hyper responds to allergens

Manifestation
o Intermittent asthma
 S/S occur < 2 weeks
 Nighttime S/S occur < month
 Do not want asthma to interfere with
child’s sleep
 Does not affect child’s daily activities, may
require fast acting medication occasionally
o Persistent
 Mild = S/S > 2 weeks
 Moderate = daily symptoms but not continues
 Severe = daily signs and symptoms that are
continuous
 o Wheezing, coughing
o Anxiety
o Low SpO2
o Chest tightness, dyspnea
o Use of accessory muscles
o Increase in white blood cell count

Diagnosis
o Medical:
 *Pulmonary Function Test
 Determines lung volume, capacity rates,
flow and gas exchange
 X-ray (hyper expansion & infiltrates)
 Skin prick testing to pinpoint allergens

Medications
o Bronchodilators
 Inhalers
 Short-acting beta 2 agonists (SABA)
 Albuterol, levalbuterol
 Used for ACUTE exacerbations
 0.15mg/kg q20min x 3 doses via neb or
4-8 puffs q20min x 3 doses via MD
 Prevents exercised-induced asthma
 Exposed to an allergen that is not too
bad
  Long-acting beta 2 agonists (LABA)
 Formoterol, salmeterol
 Used to prevent exacerbations mostly
during night and reduce the use of
SABA
 Must be used with anti-inflammatory
therapy
 Cannot be used to treat acute
exacerbations
 Cholinergic antagonists
 Anticholinergic medications = atropine,
ipratropium (Atrovent)
 Blocks parasympathetic nervous
system, relives bronchospasms
 Make sure patients are using medication
correctly and how often
 Inhaler or nebulizer
 Monitor for shakiness or tachycardia
 Monitor for dry mouth with cholinergic
o Anti-inflammatory Agents
 Decrease airway inflammation
 Corticosteroids: given parenterally, orally or
inhaler
 Methylprednisolone, prednisone,
fluticasone
 Oral can be for short period of time
following asthma exacerbation
  Inhaled daily as prevention of acute
exacerbation
 Leukotriene modifiers: and mast cell
inhibitors = prevention meds that interrupt
inflammatory response
 Monoclonal antibodies: moderate-severe
allergic asthma that is uncontrolled with
corticosteroids in kids 12 years/older
 Combination meds: contain corticosteroid +
LABA
 Theophylline: taken orally
 Smooth muscle relaxation =
bronchodilation
 Narrow therapeutic range (10-
20mcg/ml)
 Can see s/s toxicity at levels of 40-60
mcg/ml (n/v/seizures, tachycardia, and
hypotension)

o Nursing care
 Observe for s/s of thrush from steroids
 Oral/iv steroids you need to monitor weight,
BP, glucose, electrolytes, and growth
 Drink plenty of fluids
 Take steroid with food
 Rinse mouth after use of steroid inhaler
 Follow Rx: taper off complete all
medication