childhood asthma

1. PREPARED BY :
ULFAT AMIN
MSC PEDIATRIC NURSING

2. Introduction
Asthma is a non-communicable chronic lung disease,
characterized by the following features:
 Airway inflammation
 Airway obstruction mainly due to muscle spasm,
associated with mucosal edema and stagnation of the
mucus
 Airway hyper-reactivity to aerobiological irritants.

3. INCIDENCE
The incidence of asthma has steadily increased in both
developed and developing countries from 1970 to 2000.The
prevalence of asthma has increased 61% over the last two
decades.
 Asthma is the leading chronic illness among children.
 Asthma results in 10 million lost school days and 3 million lost
work days.
 Deaths from asthma have increased by 31% since 1980.
 By 1 year – 26%
 1-5 years – 51.4%
 > 5 years – 22.3%
 77% Of Asthma Begins In Children Less Than 5 Years.

4. ETIOLOGY
1. Host factors:
1. Genetic; Genes predisposing to airway hyper responsiveness
2. Sex: More in males 2:1
2. Environmental factors:
2.1 Allergens –
 Indoor – Domestic mites, furred animals (dogs, cats, mice), cockroach
allergens, fungi, molds, yeasts.
 Outdoor – Pollens, fungi, molds, yeasts.
2.2 Infections: (predominantly viral in 40% of children)
2.3 Seasonal: Seasonal variation of asthma attacks is experienced
by 35% of children.
2.4 Diet: certain foods also trigger it ( peanuts, eggs, wheat).

5. 3. Sensitization to allergen.
4. Pollutants (particularly environmental tobacco smoke,
mosquito coil smoke, sprays, perfumes etc).
5. Respiratory (viral) infections.
6. Psychosocial factors.
7. Drugs (aspirin, beta blockers)

6. PATHOPHYSIOLOGY
 Asthma is a complex condition where interaction of genetics and
environment occurs involving many inflammatory cells which release a
wide range of variety of mediators.
 These mediators act on the cells of the airway leading to smooth muscle
contraction, mucus hyper secretion, plasma leakage, edema, activation of
cholinergic reflexes and activation of sensory nerves, which lead to
amplification of the continuing inflammatory response.
 The chronic inflammation leads to structural changes, including sub-
epithelial fibrosis and smooth muscle hypertrophy and hyperplasia. This
late process is less easily reversed than the acute changes and might end up
with airway remodeling.

7. Asthma trigger
Inflammation & edema of the mucous membranes.
Accumulation of tenacious secretions from mucous
glands.
Spasm of the smooth muscle of the bronchi &
bronchioles
Decreases the caliber of the bronchioles.

8. CLINICAL MANIFESTATIONS:
The classical manifestations are: dyspnea,
wheezing, & cough.
 The episode of asthma usually begins with the child
feeling irritable & increasingly restless.
 Nocturnal Cough/Breathlessness.
 Asthmatic child may complain headache, feeling tired,
& chest tightness.

9.  Respiratory symptoms:
 Recurrent cough:
 Post-tussive vomiting (vomiting after a bout of coughing)
occurs in 5% of cases
 Abdominal pain rarely occurs due to over-working of
expiratory abdominal muscles
 Chest pain is present rarely.
 Other comorbid conditions like allergic rhinitis, sinusitis,
serous otitis media, eczema etc.
 Shortness of breath, prolonged expiration, wheezy chest,
cyanosed nail beds, & dark red color lips that may progress
by time to blue. .

10. DIAGNOSIS
1. History taking (Ask)
 Has the child had an attack or recurrent episode of
wheezing (high-pitched whistling sounds when breathing
out)?
 Does the child have a troublesome cough which is
particularly worse at night or on waking?
 Is the child awakened by coughing or difficult breathing?
 Does the child cough or wheeze after physical activity (like
games and exercise) or excessive crying?
 Does the child experience breathing problems during a
particular season?

11. 2. Physical Examination (Look).
 Dyspnea, Expiratory wheeze, Accessory muscle
movement, Difficulty in feeding, talking, getting to
sleep
 Irritability to Cough
 Eczema, Allergic Rhinitis
3. Chest x ray: Chest X-ray is not needed to diagnose
asthma. It is needed only when the diagnosis is not
clear or any complications are suspected.

12. MEDICAL MANAGEMENT
1. Oxygen : Give oxygen to keep oxygen saturation > 95% in all
children with asthma who are cyanosed (oxygen saturation ≤
90%) or whose difficulty in breathing interferes with talking,
eating or breastfeeding.
2. Pharmacotherapy:
 Quick relievers: Used for acute attacks to relieve bronchospasm as
and when needed.
 Salbutamol
 Terbutaline
 Adrenaline
 Aminophylline
 Preventers: Used for long-term to control the inflammation and to
prevent further attacks.
 - Steroids ( Oral and Inhaled) like prednisolone.
 - Theophylline

13.  Long-term symptom relievers: Used to relieve
bronchospasm for longer hours.
 – Salmeterol
 – Formoterol
 – Bambuterol
Always use with inhaled Steroids

14.  If the methods of delivering salbutamol are not
available, give a subcutaneous injection of adrenaline
at 0.01 ml/kg of 1:1000 solution (up to a maximum of
0.3 ml), measured accurately with a 1-ml syringe. If
there is no improvement after 15 min, repeat the dose
once.
 Magnesium sulfate : Intravenous magnesium sulfate
may provide additional benefit in children with severe
asthma treated with bronchodilators and
corticosteroids. Give 50% magnesium sulfate as a bolus
of 0.1 ml/kg (50 mg/kg) IV over 20 min.

15.  Oral bronchodilators : Use of oral salbutamol (in
syrup or tablets) is not recommended in the treatment
of severe or persistent wheeze. It should be used only
when inhaled salbutamol is not available for a child
who has improved sufficiently to be discharged home.
Dosage is Age 1 month to 2 years: 100 μg/kg (maximum,
2 mg) up to four times daily – Age 2–6 years: 1–2 mg up
to four times daily.

16. NURSING MANAGEMENT
The management of asthma includes:
 Education
 Environment control
 Evaluation
 Emotional support
 Regular follow-up.

17. 1. Education: The nurse must spend time to clear the misconceptions
about the disease, sexual bias, non-communicability of the disease, fear
of inhalers, steroids, etc.
2. Environment Control
It is the most important factor in the control of asthma. The aim should be
to avoid allergens and irritants:
 Dust mites: Avoid carpets, use plastic covers to pillows and mattresses;
and expose to sunlight once a week; wash soft toys periodically; and wet
mop the floorings.
 Cockroach: Cover garbage and unused food containers.
 Fungus: Attend to damp walls, have good ventilation and clean the
shower curtains weekly.
 Pets: Keep them away from sleeping area, if possible outside the house
 Avoid strong odors, smoke, mosquito coil burning, and especially tobacco
smoke.

18. 3. Evaluating respiratory status and patients general
condition
 Frequent assessment of respiratory pattern.
 Cyanosis
 Breath sounds
 Vital signs
 Cerebral functions

19. 4. Providing emotional support:-
 Calm and quiet approach
 Trusting relationship
 Reassurance
 Play and recreation
 Parental participations
5. Positioning:-
 Comfortable sitting position and supporting with
pillow.
 Leaning forward with support may be allowed
 Administering oxygen

20. 6. Administering fluid therapy:-
 During asthma they take less fluid.
 Vomiting and insensible loss due to hyperventilation.
 Maintain input output chart
7. Maintaining adequate dietary intake:-
 Clear liquids in small amounts.
 Allergic foods to be avoided.
 Spicy and gas forming foods to be avoided.
 Balanced diet.

21. 7. Maintenance of hygienic measures:-
 Routine hygiene care.
 Dust and allergen free environment.
 Aseptic technique.
8. Supporting parents and family
 Emotional support
 Parent participation in care
 Discuss treatment plan.
 Health education.

22. BIBLIOGRAPHY
1. Datta Parul, “pediatric nursing”,3rd edition,Jaypee Publishers,2014.
2. Marlow R.Dorthy,Redding.A.Barbara, “pediatric nursing”, Elsevier,
2013.
3. Pediatric nursing by piyush gupta.
4. Essentials of pediatric nursing by J.Hokenberry and David Wilson .
5. Pocket guide for asthma management and prevention, Global
Initiative for Asthma (GINA) 2011. www.ginasthma.org/guidelines-
pocketguide-for-asthma[accessed on Nov 18th2013
6. National Asthma Education and Prevention Program: Expert Panel
Report 3 (EPR-3): Guidelines for the Diagnosis and Management of
Asthma-Summary Report 2007.
7. Hazir T, Das C, Piracha F, Waheed B, Azam M. Carers' perception of
childhood asthma and its management in a selected Pakistani
community. Arch Dis Child. 2002;87:287–90.
8. Riekert KA, Butz AM,. Caregiver-physician medication concordance
and under treatment of asthma among inner-city children.