ASTHMA IN CHILDREN

I.C.SILUMESII
4TH YEAR DNS STUDENT
UNZA
 GENERAL OBJECTIVE
• At the end of the lesson, student nurses
should be able to demonstrate an
understanding on the management of asthma
in children.
 SPECIFIC OBJECTIVES
At the end of the lesson, students should be
able to;
• Define asthma.
• Outline the predisposing factors to asthma
• Explain the pathophysiology of asthma
• Describe the signs and symptoms of asthma in
children.
• Describe the management of asthma
 INTRODUCTION
• Asthma in children which is a common chronic
respiratory condition and a leading cause of
chronic illness and is characterised by the
presence of air flow obstruction which is
reversible spontaneously or with treatment
 Definition
• Asthma is a chronic inflammatory disease of
the airways that causes airway hyper
responsiveness, mucosal oedema and mucus
production. It is characterised by cough,
wheezing and dyspnoea.
 PREDISPOSING FACTORS

• Presence of allergies
• Family history of asthma and/or allergies
• Frequent respiratory infections
• Low birth weight
 PATHOPHYSIOLOGY
• Following exposure to allergens and other
irritants, mast cells in the airway mucosa
appear to initiate both an immediate
bronchospastic response which results in a
two phase alteration in the airway reactivity.
Mast cells derived mediators such as
histamine and leukotrienes produce
immediate bronchoconstriction.
• This appears to be the major feature of the
immediate response .
• The chemical mediators then release a protein
which damages airway epithelium and induce
further mast cell mediator release.
• Exposure to tobacco smoke before and/or
after birth
• Being male
• Being black
• Being raised in a low-income environment
• Allergen exposure e.g. mites, pollen.
• Viral respiratory infections.
• Irritants e.g. smoke, sulphur dioxide.
• Exercise e.g. running
• Climate e.g. cold air
• Emotions e.g. Laughter, crying.
 SIGNS AND SYMPTOMS

• Frequent coughing spells, which may occur

during play, at night, or while laughing. It is
important to know that cough may be the only
symptom present.
• Less energy during play
• Rapid breathing
• Complaint of chest tightness or chest
"hurting"
• Whistling sound (wheezing) when breathing in
or out
• See-saw motions (retractions) in the chest
from labored breathing
• Shortness of breath, loss of breath
• Tightened neck and chest muscles
• Feelings of weakness or tiredness
• Dark circles under the eyes
• Frequent headaches
• Loss of appetite
SIGNS AND SYMPTOMS OF SEVERE ATTACK

• Anxiety
• Restlessness
• Tachycardia
• Intense wheezing on auscultation
• Whispering speech
 Differential Diagnosis
• Foreign bodies in the airway.
• Tonsilar abscess
• Bronchitis
• Pneumonia
• Tuberculosis
• Congestive cardiac failure 
 INVESTIGATIONS
• History of coughing, dyspnoea, medicines and
family history.
• Exercise test- A child is made to run for 6 minutes
on a tread mill at a work load sufficient to
increase the heart rate above 160 beats /
minute.
• C XR –The lungs will appear hyper inflated .
• The lateral view demonstrates a pigeon chest
deformity.
• CT scan to rule out other conditions that can
cause similar symptoms
• ABG analysis- Pa of carbon dioxide may rise to
>/= 45mmHg
• Pulmonary function test –this is the
measurement of peak expiratory flow (PEF)
 MEDICAL MANAGEMENT (Acute Attack)

AIMS
• To relieve the symptoms
• To restore normal lung function
• To reduce the risk of severe attacks
• RELIEVERS
Beta 2 agonist bronchodilators in inhaled form
Eg Salbutamol puffs
Given by metered dose.
Side effects- tremors of the hands,
headache, palpitations and tachycardia
• Nebulization
• Oxygen should be used to nebulize the
bronchodilator. Salbutamol can be used in
respirator solution via face mask nebulizer.
Dose 2.5mg tds or qid.
• If using a solution for inhalation or nebulizer
use 2.5mg tds or qid sometimes.
• If there is no response to two nebulisations
given 1 hour apart, the child must be managed
for acute severe asthma
MANGEMENT OF ACUTE SEVERE ASTHMA

• Hospitalize patient preferably in an intensive

care unit.
• Treat Hypoxaemia by giving oxygen via face
mask 2 litres/ minute
• Nebulize with Beta2 agonist preparations. Give
1 ml Salbutamol respirator solution diluted
with 1ml of normal saline in the nebulizer.
Repeat continuously.
• Administer steroids oral predinisolone1-2
mg/kg body weight or hydrocortisone 2 mg/
kg IV. The dose is repeated daily if oral and 6
hourly if IV. When child improves, give
prednisolone for 10 days.
• ANTIBIOTICS
E.g. Amoxyl suspension 20mg/ kg tds for 5
days
Side Effects Urticaria, Hypersensitivity
reactions, nausea and vomiting.
• BROCHO DILATORS These should only be used
where there are facilities for measuring the
serum levels as it can cause severe toxicity
symptoms i.e. hypotension, severe headache,
drowsiness
(normal levels <9.9 mcg/ml)
• Aminophylline 5-7mg /kg body weight given in
20 minutes.
Side Effects Dizziness, Drowsiness and anxiety.
 NURSING MANAGEMENT
• Immediate nursing management depends on
the severity of symptoms. Usually patient is
treated successfully as an out patient if
symptoms are mild but may require
hospitalisation for moderate to severe
symptoms
• ADMISSION
Admit a patient in a well ventilated room
which is warm and clean to promote comfort
and prevent smooth muscle constriction if the
room is cold. Administer oxygen 2L/ minute to
allow adequate tissue perfusion
• POSITION
Nurse patient in a sitting position(Fowlers
position) to aid breathing in the removal of
excess fluid within the bronchi and to dislodge
a plug of mucus hence aid lung expansion.
• DRUG THERAPY
Humidified oxygen is given in severe condition
where patient has severe dyspnoea and is
cyanosed.
Administer patient’s prescribed drugs and
monitor the progress.
• OBSERVATIONS
Vital signs are done according to severity of
the condition. Observe respirations to detect
any distress in the patient how shallow or how
deep they are.
• Observe for dyspnoea whether mild or severe
by observing the intercostals retraction.
• Observe for cyanosis of the skin or lips to
detect if there is improvement or not.
• NUTRITION AND FLUIDS
Prepare meals that are attractive to eat. Avoid
highly spiced foods to prevent occurrence of
the asthmatic attacks. A bland diet is
preferred. Offer plenty of fluids to liquefy the
mucus and easy coughing. If patient is too
dyspnoeic to eat orally, an intravenous infusion
can be started. E.g. Dextrose 5% 1 litre in 24
hours.
• Explain to both patient and family that all is
being done to relieve the dyspnoea so that
their anxiety is allayed.
• Allow one of the relatives to always be by the
bed side of the patient in order to make the
patient feel cared for.
• Explain all procedures that are done on the
patient and relatives in order to gain
cooperation.
• Allow patient and relatives to verbalise their
fears and concerns in order to let them vent
out
• IEC
• Teach client and care giver or relatives to
observe the triggers of an asthmatic attack
and try to avoid them if possible.
• Clients’ relative should be educated on the
importance of giving the patient drugs and
according to the prescribed orders.
• Tell patient’s mother or care giver to have the
patient treated promptly for any chest
infection to prevent recurrent attacks.
• Encourage patient to sleep in a propped up
position and parents to keep the child warm
at night.
 SUMMARY
• Asthma is a long term condition that affects
the airways and breathing. The airways are
sensitive and easily become swollen. When
the mucous membranes are irritated, they
narrow, muscles around them tighten and
there may be increase in the production of the
sticky mucus
• This makes it harder to get enough breath and
causes wheezing, coughing and the chest may
feel tight. Asthma is partly an allergic
condition and is also genetic. The predisposing
factors are dust, animal fur pollen cold air and
smoke and the signs and symptoms are
wheezing, coughing, tachycardia and tightness
of the chest
• Then the management is aimed at abolishing
symptoms, restoring normal lung function and
reducing the risk of severe attacks.
THE END