asthma in children

2.  Asthma in children is common. Asthma is
a chronic disease that causes in the air way
they tube that carry air in and out of your
lungs to become sore and swollen.
 Children have smaller air way than adults
which makes asthma especially serious for
them
 An asthma attacks occurs when their air
ways narrow and the mucus around them
tightly contract.

3. Asthma is a condition of
the lungs in which there
is an air way obstructing
due to spasm of the
bronchial smooth muscle,
edema of mucosa and
increased mucus
secretion in the bronchi
and bronchioles brought
on the various stimuli.

4. 1. ACUTE ATTACK: It is sporadic in nature.
2. LATENT ATTACK: No outward signs or
symptoms of asthma are seen but there is
some shortness of breath or wheezing
occasionally observed.
3. INTRACTABLE ASTHMA: There is
persistent wheezing and the requires
regularly and daily medications for the
control of symptoms.
4. STATUS ASTHMATICUS: It is serves attack
in which the patient deteriorates in spite of

5. CAUSES
1. Allergens: Pollen, mold, animals, foods.
2. Irritants: Diet, chemical, air pollution, vapour
from wood products, cigarette smoke, gases,
odor, house hold cleaners, perfumes
3. Weather: Cold air, changes in weather
4. Exercise
5. Psychological & emotional stress (fear and
excitement)
6. infection: flu, common cold, sore throat,
bronchitis.

6.  Strong hereditary factor
associated with distress.
 patient and their family have
history of asthma ,
 atopic dermatitis (eczema, skin
rash)
 Allergic rhinitis (Hay fever)

8. Non immunological stimuliNon immunological stimuli ImmunologicImmunologic
stimulistimuli
(Viral infection, Physical, chemical stimuli)(Viral infection, Physical, chemical stimuli) (Antigens)(Antigens)
Cell ActivationCell Activation
Mast cellsMast cells
(Epithelial cells, Esinophils lymphocytes, macrophages)(Epithelial cells, Esinophils lymphocytes, macrophages)
Inflammatory mediatorsInflammatory mediators
(smooth muscle contraction chemo taxis)(smooth muscle contraction chemo taxis)
Granulocytic responsesGranulocytic responses
(nutrophil, esinophils, basophile, activated mono nuclear cells)(nutrophil, esinophils, basophile, activated mono nuclear cells)
Inflammatory mediatorsInflammatory mediators
Air way edema, cellular infiltration sub epithelial fibrosis, mucus secretionAir way edema, cellular infiltration sub epithelial fibrosis, mucus secretion
Air way hyper responsivenessAir way hyper responsiveness
Asthma (recurring attack of wheezing shortness of breath prolonged expirationAsthma (recurring attack of wheezing shortness of breath prolonged expiration
on irritated coughon irritated cough

10. Mild Moderate severe
Breathlessness With activity With talking At rest
speech sentences phases Words
Body position Able to recline Prefers sitting Unable to recline
Breath sounds Wheezing at end
expiration
Wheezes
throughout
Inspiration and
expiration
Heart rate
(above 10 yrs)
<100 100 - 120 >120
pulses <10 10 - 25 >25
Paradoxus (mm.
Hg)
>80 50 - 80 <50
Pa O2 Normal >60 <60
PacO2 <42 <42 >42
SaO2 (% Room
air)
>95 91 - 95 <91

12. • The on set may be gradual with nasal
congestion and sneezing
• The attack may sudden, generally at
night
• Wheezing with the expiration, anxiety,
uncontrollable cough is present
• Dyspnoea, thick tenacious mucus,
coarse release, flaring of the nostrils

13. • Cyanosis, hypyrcapnoa, increased pulses,
increased respiratory rate.
• Vomiting, anxiety, agitation
• Cough - at night and in the early of the
morning
• Pain or a tight feeling in the chest.
• Shortness of breath
• In sever case bluish skin around the lips and
fingers.

14.  Proper history collection
 Physical examinations
 Laboratory test (nasal secretions
and sputum's)
 Complete blood test (eosinophilia in
the peripheral blood)
 Poly morphonuclear leucocytosis
in the presence of infection

15. 1.1. Medical ManagementMedical Management:
Asthma is not a curable disease but it can be
controlled by taking medications like
quick relief medication (to stop asthma
symptoms
Long term control medications ( to prevent
symptoms )

16. • Bronchodilators
• Short acting inhaled Beta 2 agonist
Albuterol
Nebulizer – 0.15 mg / kg
Metered dose inhalor
90 mcg / puff : 4- 8 puffs
Lebarbuterol
Nebulizer – 0.075 mg / kg
pirduterol
Metered dose inhalor 200 mcg / puff :4-8
puffs

17. • Systamic (Injector) Beta 2 agonist
 Epinephrine 0.01 mg / kg – 0.3 – 0.5 mg
 Terbutaline 0.01 mg / kg
• Anticholinergics
 Ipratropium bromide
 Nebulizer 0.25 mg
 Metered dose inhalor 4 – 8 puffs
 Systomic corticosteroids
 Prednisolone
 Methylprednisone 1 mg / kg

18. • Severe persistent:
High dose of inhaled corticosteroids
Long acting inhaled beta 2 agonists
• Moderate persistent:
Medium and low dose inhaled corticosteroids
Long acting inhaled beta 2 agonists
• Mild persistent:
low dose inhaled corticosteroids
cromolon or leukotriene receptor antagonist
• Mild intermittent:
no daily medications in needed

19. • Inhaled sodium cromoglycate
nedocromil
• Inhaled corticosteroids
declomethasone, budesonide,
fluticasone
• Sustained release preparation of
theothyllines
• Long acting B2 agonist (salmeterol,
formoterol)

21. • Observe the severity of the attack
and the degree of respiratory
distress should be observed
• Breathing pattern should be
noted for expiratory dyspnoea
• The level of children anxiety
should be noted
• Patient should be observe red for
cyanosis
• Measure to relieve respiratory
distress

22. • If sings of air hunger are observered the
Oxygen should be administer
• Reassurance may help to reduce the
anxiety
• When the patient are sleep should not
be disturbed unless it is necessary
• The normal diet can be started when the
patient can be take it
• Proper breathing habit should be
encouraged
• The dehydration should be treated by
providing adequate fluids.

23. Environment control
• Provide a dust free environment for
child
• Keep child out of smoke filled
environment
• Encourage child to avid areas where
molds grow .
Medication administration
• Observe child for side effect of drugs
• Administer prescribed medication

24.  Breathing exercise
Practice of lips and diaphragmatic exercise
 Support of growth and development
Active play
Encourage activities with the peer groups
 Parental advice
• Parent should be advice about
development of healthy habits their
children
• Children should be provided balanced diet
• The allergences should be avoided
• The regular follow up should be attended

26.  Wong's, nursing care of infants and children,
seventh edition ,page number 1385-1440
 Satish kumar , hand book of pediatrics fourth
edition, published by “All India publishers”
page number 139-158
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