Asthma Attack

DEFINITION

• Child is having an asthma attack
• Don't use this guideline unless the child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician

• A wheeze or whistling (purring) sound on breathing out is the classic symptom
• Coughing may be the first symptom of an asthma attack

• Viral respiratory infections
• Animal contact (especially cats)
• Tobacco smoke or menthol vapors
• Pollens
• Air pollution (e.g., barn, circus, wood stove, dirty basement)

• Mild: no Shortness of Breath (SOB) at rest, mild SOB with walking, speaks normally in sentences, can lay down flat, wheezes only heard by stethoscope (GREEN Zone: Peak Flow Rate 80-100% of baseline level or personal best)
• Moderate: SOB at rest, speaks in phrases, prefers to sit (can't lay down flat), audible wheezing  (YELLOW Zone: Peak Flow Rate 50-80% of baseline level)
• Severe: severe SOB at rest, speaks in single words (struggling to breathe), usually loud wheezing or sometimes minimal wheezing because of decreased air movement (RED Zone: Peak Flow Rate less than 50% of baseline level)

See More Appropriate Topic (instead of this one) If

• No previous asthma diagnosis or use of asthma medicines, see WHEEZING

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR ASTHMA ATTACK

1. Asthma Rescue Medicine:
   • Start your child's quick relief medicine (e.g., albuterol inhaler or nebs) at the first sign of any coughing or shortness of breath (don't wait for wheezing). (Reason: Early treatment shortens the asthma attack).
   • The best "cough medicine" for a child with asthma is always the asthma medicine.
   • Follow your child's action plan for asthma attacks.
   • For albuterol inhalers, give 2 puffs separated by a few minutes, every 4 to 6 hours.
   • Continue the asthma rescue medicine until your child has not wheezed or coughed for 48 hours.
   • Spacer: Always use inhalers with a spacer. It will double the amount of medicine that gets to the lungs.
2. Asthma Controller Medicine: If your child is using a controller medicine (e.g., inhaled steroids or cromolyn), continue to give it as directed.
3. Hay Fever: For nose allergy symptoms, it's OK to give antihistamines. (Reason: poor control of nasal allergies makes asthma symptoms worse)
4. Fluids: Encourage drinking normal amounts of clear fluids (e.g., water) (Reason: keeps the lung mucus from becoming sticky).
5. Humidifier: If the air is dry, use a humidifier (Reason: to prevent drying of the upper airway).
6. Avoid or Remove Allergens: Give a shower to remove pollens, animal dander, or other allergens from the body and hair. Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows). Avoid exercise during the attack.
7. Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
8. Call Your Doctor If:
   • Difficulty breathing occurs
   • Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours
   • Wheezing persists over 24 hours
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.