This document outlines the key objectives and content of a lecture on pediatric asthma. It will define asthma, discuss prevalence and risk factors, identify trends, warning signs, triggers, causes, clinical manifestations, diagnosis, prevention, and management of asthma. It will also describe asthma complications. The lecture aims to educate students on pediatric asthma through discussing its definition, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, treatment and nursing management.

2. Objectives
At the end of this lecture the student will be able to :
1. Define Asthma
2. Illustrate the Prevalence and facts about asthma
3. Explain the Potential Risk Factors for asthma
4. Identify New trends in pediatric asthma
5. Mention the warning signs of asthma
6. Describe the asthma Triggers
7. Discuss the causes of asthma
8. Enumerate the clinical manifestations of asthma
9. Explain the diagnosis of asthma
10. Discuss asthma prevention
11. Mention the management of asthma (Medical/Nursing)
12. Describe the complications of asthma

3. WHAT WE KNOW ABOUT
PAEDIATRIC ASTHMA?

4. Or a combination of all three
Swelling
Inflammation Excess mucus
Asthma is a condition of the airways where there is
difficulty in breathing due to
WHAT IS PAEDIATRIC ASTHMA?

5.  A chronic inflammatory disorder of the airways
characterized by:
Airway inflammation
Airflow obstruction
Airway hyperresponsiveness
 It is treatable, but not yet curable
 Not contagious
 Can be life-threatening!

7. • It is the most common chronic childhood disease.
• The prevalence of children asthma in Saudi Arabia varies
among different regions throughout the country. The highest
prevalence was reported in Alhofuf (33.7%) and the lowest in
Abha (9%) (Alahmadi, 2019).
• Asthma causes more hospital stays than any other childhood
disease
• It is a leading cause of school absences
• Cost of lost workdays of parents with asthmatic children is
near $1 billion Dollars in USA.

8.  Asthma is a globally significant non-communicable
disease with major public health consequences for both
children and adults, including high morbidity, and
mortality in severe cases.
 While asthma incidence and prevalence morbidity are
higher in children, and mortality are higher in adults.
 Childhood asthma is more common in boys while adult
asthma is more common in women, and the reversal of
this sex difference in prevalence occurs around puberty
suggesting sex hormones may play a role in the etiology
of asthma.

9. There are many risk factors for developing
childhood asthma. These include:
 Family history of asthma or allergies
 Frequent respiratory infections
 Low birth weight
 Exposure to tobacco smoke before or after
birth
 Being male
 Being black
 Being raised in a low-income environment

10. • Infections (viruses)
• House-dust mite
• Pets (feathered)
• Smoking
• Exercise
• Pollens

12.  Single allergen reduction not
effective
 “Treatment by means of
allergen avoidance requires
the definition of what
patients are allergic to, and
health education”

13.  The main cause is unknown
 Asthma is a complex trait
◦ Environmental factors contribute to its pathogenesis.
Viral infections appears have an expanding role as well.
◦ Onset appears early in life and severity remains constant
 Multiple interacting genes
◦ At least 20 distinct chromosomal regions with linkage to
asthma and asthma related traits have been identified.

14. • Coughing
• Wheezing
• Fast breathing
• Poor skin color
• Shortness of breath
• Restless during sleep
• Fatigue
• Anxiety
• Vomiting

16.  Night cough, disturbed sleep
 Restriction in activity/exercise
 Increased school absences
 Ongoing symptoms may have an effect on physical,
psychological and social well-being

17.  Unpredictable and variable
◦ Recurrent episodes of wheezing, breathlessness, cough,
and tight chest
◦ May be abrupt or gradual
◦ Lasts minutes to hours
• Expiration may be prolonged
◦ Inspiration-Expiration ratio (I:E) of 1:2 to 1:3 or 1:4
◦ Bronchospasm, edema, and mucus in bronchioles narrow
the airways
◦ Air takes longer to move out

19.  Clinical diagnosis supported by the certain historical,
physical and laboratory findings
◦ History of episodic symptoms of airflow obstruction
(e.g. breathlessness, wheezing)-response to therapy!
◦ Physical: wheeze, hyperinflation
 Identify precipitating factors (pets, mold,…)
 Assess the patient/families knowledge and self
management skills
 Classify asthma severity

20. Complete history
• For common allergen to diagnosis and identify trigger
allergens
Skin prick test
CXR
• For >5y
• Diurnal variability (morning < evening) and day-to-day
variability
• Bronchodilator responsiveness, increase by more than 10 to 15%
Peak Expiratory Flow Rate (PEFR)

21. Height (cm) PEFR
(L/min)*
120 215
130 260
140 300
150 350
160 400
170 450
180 500
This is a simple method of measuring
airway obstruction and it will detect
moderate or severe disease.
Normal values are related to the
patient's height as follows:
Peak Expiratory Flow Rate (PEFR)

22.  > 4 episodes/yr of
wheezing lasting more
than 1 day affecting
sleep in a child with
one MAJOR or two
MINOR criteria
 Major criteria
◦ Parent with asthma
 Minor criteria
◦ Physician diagnosed
allergic rhinitis
◦ Eosinophilia (>4%)
◦ Wheezing apart from colds

23.  No single action has been demonstrated to decrease the
risk of developing asthma
 Prevention will depend on factors influencing the
development and progression of asthma

24.  Wash bed linens weekly
 Avoid down fillings
 Limit stuffed animals to those
that can be washed
 Reduce humidity level

25. Evidence suggests an association
between environmental tobacco
smoke exposure and exacerbations
of asthma among school-aged,
older children, and adults.
Evidence shows an association
between environmental tobacco
smoke exposure and asthma
development among pre-school aged
children.

26. Remove as many water and food sources as possible to avoid
cockroaches.
4. Reducing Exposure to Pets
People who are allergic to pets should not have them in the
house. At a minimum, do not allow pets in the bedroom.

27. Eliminating mold and the moist conditions that permit mold
growth may help prevent asthma exacerbations.

28. Air pollution
Trees, grass, and weed pollen

29. Despite high dose of inhaled bronchodilator, they:
Not responded adequately clinically
Exhausted
Marked reduction in predicted Peak Expiratory
Flow rate (PEFR)
<92% of O2 saturation
Investigation
CXR- unusual
features
Arterial blood gases
– life threatening

30.  Control chronic and nocturnal symptoms
 Maintain normal activity levels and exercise
 Maintain near-normal pulmonary function
 Prevent acute episodes of asthma
 Minimize emergency department (ED) visits and
hospitalizations
 Avoid adverse effects of asthma medications

31. Bronchoconstriction
Excessive mucus
production
Mucosal edema due
to inflammation

33. 33
Mouth and
pharynx
Lung deposition
(10% to 30%)
Systemic circulation
Inactivation in
the liver “first pass”
Absorption
from the gut
Swallowed
fraction
(70% to 90%)
Lung
Absorption
from the
lung (A)
GI tract
Active drug
from the gut
(B)
Systemic concentration = A + B
Liver

35.  Complications of status asthmaticus
◦ Pneumothorax
◦ Acute cor pulmonale
◦ Severe respiratory muscle fatigue leading to
respiratory arrest
◦ Death is usually result of respiratory arrest or
cardiac failure

36. Acute
Determine the severity
Breathlessness to talk and eat??
Increased work of breathing- Severe
tachypnoea: >30C/m
Auscultation – wheeze / silent chest ,
Pulse - Severe > 120bpm
Consciousness, exhaustion, cyanosis
(tongue)
Peak flow (% predicted)
• Moderate - 92%
• Severe - < 92%
O2 saturation
Chronic
Growth and nutrition
Peak flow
Chest: hyperinflation, wheeze
Allergic disorder
• Severity and frequency of symptoms
• Exercise tolerance
• Interference with life: school, sleep
• Inhaler technique
Monitor
Triggers ??

37.  Ineffective airway clearance related to accumulation of
mucus
 Anxiety related to deficient knowledge
Nursing planning
 Overall Goals
◦ Maintain greater than 80% of personal best Peak Expiratory Flow
Rate
◦ Have minimal symptoms
◦ Maintain acceptable activity levels

38.  An important goal of nursing is to ↓ the child’s sense of panic
◦ Stay with him
◦ Encourage slow breathing using pursed lips for prolonged
expiration
◦ Position comfortably
 Ambulatory and Home Care
◦ Must learn about medications and develop self-management
strategies
◦ Patient and health care professional must monitor
responsiveness to medication
◦ caregiver must understand importance of continuing
medication when symptoms are not present