- Clinical therapy includes medications, hydration, education, and support of parents and
child. Pharmacologic therapies are matched to the severity of asthma for long-term
control and for management of acute episodes. The goal is to maintain asthma
control long term using the least amount of medication, thus reducing the risk for
- Children should be encouraged to participate in physical activities and exercise.
- Children with exercise-induced asthma have a history of coughing, breathlessness,
chest pain, or wheezing that occurs during and after exercise.
- A spirometry or PEFM reading of a 15% decrease in peak flow with exertion is usually
- Pretreatment with short-acting beta2-agonists immediately before exercise often
prevents exercise-induced asthma and provides relief for up to 3 hours.
Acute asthma episodes
- Most children with acute exacerbations respond to aggressive management in the
emergency department, including continuous albuterol by nebulizer, oral systemic
corticosteroids, and inhaled ipratropium.
- Chest physiotherapy is not beneficial and it causes unnecessary stress to the child.
Children who do not respond or who are already being managed at home on
corticosteroids have a greater chance of hospital admission.
Severe asthma exacerbations
- Some children with severe (potentially life-threatening) asthma exacerbations need
aggressive and immediate intervention in the intensive care unit, such as those who
had an emergency department or private physician visit in the prior 24 hours.
- These children may progress to respiratory failure and die. The child is placed on a
cardiorespiratory monitor and pulse oximeter.
- Intravenous magnesium sulfate may be used in addition to other medications used
for the acute exacerbation.
- Heliox (70% helium, 30% oxygen) may be used to drive the nebulizer. Some
children will need mechanical ventilation or CPAP.
Maintain Airway Patency
- If the child is exhibiting breathing difficulty, give supplemental oxygen by nasal
cannula or face mask. Humidified oxygen should be used to prevent drying and
thickening of mucous secretions. The child should be placed in a sitting (semi-Fowler)
or upright position to promote and ease respiratory effort. Medication Used to treat Asthma
NURSING MANAGEMENT ACTION/INDICATION QUICK-RELIEF
■Use this rescue medication Relaxes smooth muscle in Short-Acting Beta2-Agonists
before inhaled steroid, wait airway leading to rapid (SABA)Albuterol
1–2 minutes between puffs, bronchodilation (within 5–10 Levalbuterol
wait 15 minutes to give minutes) and mucus clearing Pirbuterol:Metered dose
inhaled steroid. Child should Drug of choice for acute inhaler (MDI) or nebulizer
hold breath 10 seconds after therapy and for prevention of
inspiring. Then rinse mouth exercise-induced
and avoid swallowing bronchospasm
medication. Use a spacer.
■Differences in potency exist,
but all products are
comparable on a per puff