Pediatric Asthma Management
Asthma as defined by National Asthma Education and Prevention Program is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, neutrophils and epithelial cells.
When mast cells activate, there is infiltration of inflammatory cells, edema, denudation and disruption of the bronchial epithelium, goblet cell hyperplasia and smooth muscle thickening resulting to asthmatic inflammation.
Signs and symptoms:
- Recurrent episodes of wheezing
- Chest tightness
- Cough particularly at night and in the early morning
- Children before age of 5
- “hygiene hypothesis” (suggests that living in a clean environment may predispose the immune system of the child towards allergic reactivity
- Weather changes
- Viral or sinus infections
- Reflux disease
- Medications (sensitivity to aspirin, NSAIDs sulphites)
- Emotional anxiety
- Use of short acting bronchodilator which is inhaled beta2-agonists as needed for symptoms with MDI spacer/holding chamber
- Bronchodilators should be given every 4 to 6 hours for 24 hours for patient with asthma and viral infection.
- Regular monitoring and assessment of the symptoms in the past 2 weeks.
- Assess for exacerbation, proper compliance to medications.
- Assess for difficulty with feedings, changes in respiratory rate, altered sleep patterns, presence of retractions, decreased appetite and weight loss.
- Teach the parents to control or minimize the exposure to allergens.
- Emphasize the need for flu vaccine for patients with no restrictions.
- Limit the exposure to cigarette smoke
- Eliminate dust mites
- Encourage to use air conditioners at home and keep doors and windows closed to minimize the exposure to these triggers.
- Encourage a regular visit to the physician and evaluate the proper usage of equipment.
- Provide a written instruction for management plans when at home, at school or care givers.
- Remind the parents or care givers about the medications, its expiry date as well as having a reserve of it in times of exacerbations.
- Give an easy telephone access when the patient must be taken into the hospital.
Photo credits: http://health.nytimes.com