Asthma

A chronic respiratory disease where airway passages can swell and constrict, causing air to get trapped in the lungs. Causes/triggers- an item or situation that may cause irritation to the airways, causing swelling, restricting air flow and making breathing difficult.

Causes/triggers of asthma in infants and children

allergies

  • Animal fur (dogs,cats)
  • Bee stings
  • Certain foods
  • Cigarette smoke
  • Cockroach feces
  • Dust mites
  • Dusty areas
  • Exercising (running)
  • Fast temperature changes (especially cold)
  • Fighting
  • Divorce or death
  • Gasoline smell
  • Molds
  • Paint fumes
  • Perfumes/colognes
  • Sinus infections
  • Stress

Appearance (what your child might look like or be doing during an asthma attack)

asthmaenhaler

  • Sitting straight up, leaning forward or standing
  • Sweating
  • Pale skin color
  • Gray or bluish skin color
  • Grabbing at their chest and neck
  • Breathing fast
  • Tell you their chest hurts
  • Tell you they cant get enough air
  • Tell you they feel like they are going to die
  • Chest may look like it is caving in when they breath
  • Coughing
  • Only be able to say a couple words at a time
  • Hear wheezing (sounds like a whistle)
  • Will quickly get very tired
  • Have a strong itchy feeling on their body (especially their back)
  • Treatment- the primary goal is to reduce the swelling in the airways allowing for air exchange in the lungs.
  • If possible separate the child from what is causing the attack
  • Get them to a cool area (not cold)
  • Have a fan circulate air near them
  • Play relaxing music (classical,new age)
  • Quiet and calmness around the child
  • Have child sit up and lean forward
  • Loosen or take off any tight clothing

emergency

  • Calmly encourage them to breath slowly and deeply
  • Rescue inhalers per your doctor’s orders
  • Breathing machine per your doctor’s orders
  • Call 911
  • Take your child to the nearest emergency room

Nebulized Respiratory Medications

There are several medications that are nebulized and introduced directly into the lungs. These medications are very effective in treating respiratory conditions most commonly associated with patients with asthma, cystic fibrosis, tracheostomy patients, etc. Keep in mind, the following points when giving nebulized medications.

Bronchodilators

Always give Bronchodilators first, in order to open the airways. Bronchodilators are used to treat wheezing, no air movement, or very little air passages, or when signs of respiratory distress or noted. Examples of common bronchodilators include:

  • Albuterol (Proventil, Ventolin)
  • Levalbuterol HCL (Xopenex)
  • Ipratopium Bromide (Atrovent) is a type of bronchodilator that is mixed with Albuterol and Xopenex in the same nebulizer

Possible side effects: rapid heart rate, shakes or tremors, and upset stomach.

Mucolytic

Always give nebulized Mucolytics second, in order to break down or thin secretions. These medications must be used exactly as prescribed by doctor on exact times during the day/night they are prescribed. Do not use Mucomyst and Dornase Alfa during the same treatment time. You must use Separate Nebulizers for each of these medications.

Examples of common mucolytics include:

  • Acetylcysteine (Mucomyst)- typically diluted with bronchodilator
  • Dornase Alfa (Pulmozyme)- kept in the refrigerator

Possible side effects: chest pain or discomfort, cyanosis (turning blue), sore throat, or airway irritation.

Complementary treatments: if CPT (chest physiotherapy) / Vest therapy of cough assist is ordered, you would give that treatment next. Then suction the patient. The following medications take 20-30 minutes to begin to working the airway, thus no suctioning should be done during this time frame, unless the patient is in respiratory distress.

Corticosteroids

Corticosteroids are used to reduce and prevent the swelling inside the airways. These medications are considered to be preventive medications. They coat the airway to protect from possible “triggers” that may irritate and inflame the airway. They last an average of 10-12 hours. No suctioning should be performed within 20 minutes of its administration to ensure the medicine has time to take effect.

Examples of Corticosteroids include:

  • Flovent
  • Pulmicort

Possible side effects: yeast infection in the mouth (white spots inside the mouth and on the tongue). This can be reduced by rinsing the mouth out after each treatment.

Antibiotics

Antibiotics are used to treat infections in the lungs. These medications should not be given any longer than 10-14 days at a time. Check with your doctor if you are giving this medication longer.

Examples of common nebulized antibiotics include:

  • Tobramycin Sulfate (Tobi, Tobrex)
  • Gentamycin Sulfate (Garamycin)

Pearl of wisdom: Tobramycin must be nebulized in a separate nebulizer in order to prevent clumping. Discard nebulizer is clumping forms. Do not use if liquid is discolored.

Possible side effects: rash, fever (rare), upset stomach, and vomiting.