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3-12. Acute Asthma

Asthma is a congestive pulmonary disease characterized by attacks of wheezing and difficult breathing. Smooth muscles that lie in the walls of the smaller bronchi and bronchiolus become increasingly responsive to a variety of stimuli (pollens, dusts, milk, shellfish, fumes, etc.). This causes edema in the bronchi and congestion of the lining membranes of the bronchi. Additionally, the membranes which line the bronchi secrete a great deal of mucus which is hard to dislodge (cough up).

a. Signs/Symptoms of Acute Asthma. Included are the following:

(1) Interference of normal passage of air in and out of the lungs.

(2) Exhalation particularly difficult. Not all the inhaled air can be exhaled. With each breath the child takes, some air is trapped in his lungs.

(3) Chest becomes overinflated, and the sounds are overloud when the chest is percussed.

(4) Ventilation (the cyclic process of breathing in and breathing out) is progressively impaired.

(5) Worsening of these conditions:

(a) Hypoxia--abnormal reduction of oxygen in the body tissues; also called oxygen deficiency.

(b) Hypercarbia--abnormally high concentration of carbon dioxide in the blood.

(c) Acidosis--increase in the hydrogen ion concentration in body fluids accompanied by a lowering of the pH level.

(d) Dehydration--decrease in the amount of water in the body or body tissues.

(6) As acidosis worsens, bronchoconstriction (narrowing of the interior space of the bronchi) becomes severe. Dehydration causes the mucus plugs to become thicker and more tenacious. This all causes a continuous cycle.

b. Treatment of Acute Asthma. An acute attach of asthma is treated as a respiratory emergency. Treat as follows:

(1) Give oxygen to treat the child's oxygen deficiency.

(2) Administer bronchodilator medication. The drug of choice is epinephrine, 1:1000 0.01 ml/kg to 0.3 ml is the maximum dosage. The dosage may be repeated once or twice every 20 minutes. An aerosolized bronchodilator through a nebulizer may be used.

CAUTION: DO NOT administer epinephrine after the patient has used an over-the- counter (OTC) bronchodilator. Otherwise, the patient may experience severe circulatory disease or cardiac arrhythmias.

(3) Encourage fluids to treat dehydration and to loosen mucus secretions.

(4) Administer bicarbonate to treat acidosis.

(5) Some children may require steroids for a period of time to reduce the edema and congestion of the bronchial membranes.


David L. Heiserman, Editor

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Revised: June 06, 2015