Clinical Reference Systems: Pediatric Advisor 10.0
Admission and Discharge Instructions
- wheezing (a high-pitched whistling or musical sound while
- recurrent attacks of wheezing, coughing, chest tightness,
and difficulty in breathing
- sneezing and a runny nose (often but not always)
- usually no fever.
Asthma is also called reactive airway disease (RAD).
Asthma is an inherited type of "twitchy" lung. The airways
go into spasm and become narrow when allergic or irritating
substances enter them. These substances cause the lining of
the airway to swell and produce mucus. Viral respiratory
infections (colds) trigger most attacks, especially in
younger children. If the asthma is due to an allergy to
pollens, it flares up only during a particular season.
Asthma often occurs in children who have other allergic
reactions such as eczema. While emotional stress can
occasionally trigger an attack, emotional problems are not
the cause of asthma. Some common triggers are listed under
the section titled "Prevention by Avoiding Asthma Triggers."
Reasons for Admission to the Hospital
___ Needs IV fluids.
___ Needs antibiotic or other medicine.
___ Needs oxygen.
___ Other reason: ____________________________________________
Asthma attacks may be frightening, but they are treatable.
Taking medicines early can shorten the course of an asthma
attack and prevent hospitalization. When medicines are
taken as directed, the lungs usually return to normal
between attacks and there are no permanent changes. Asthma
can be a long-lasting disease, but over half of the children
who have asthma outgrow it during adolescence.
Requirements for Discharge
Discharge Instructions for Home Treatment
Asthma is a chronic disease that requires close follow-up by
a physician who coordinates your child's treatment program.
- Asthma inhalers
Your child's metered-dose inhaler is __________________.
Your child's dose is ____ puffs every ____ hours for ____
Carefully follow these instructions for teaching your
child to use the inhaler:
- Shake the medicine.
- Hold the inhaler upright and 2 inches in front of an
- Your child should breathe out (exhale) completely.
- Release the spray when your child starts to breathe
- Your child should inhale slowly until his lungs are
- Your child should hold his breath for 10 seconds
after his lungs are filled.
- After taking a few normal breaths, your child can
take the additional puff(s).
Inhalers usually can't be coordinated by children less
than 6 years old unless a plastic airway spacer (or
chamber) is also used. The spacer (chamber) traps the
asthma medicine and gives your child time to breathe it
in. Some children need to use a spacer until they are
teenagers. Your child's spacer is ________________.
- Asthma nebulizer treatments
Children younger than 4 years old can't use inhalers.
They need nebulized medicine treatment, using a machine.
Even older children get more of the medicine delivered
to their lungs using a nebulizer rather than an inhaler.
Your child's nebulizer should contain ____ ml of
_________________ mixed with ____ ml of _______________.
Give a nebulizer treatment every ____ hours for ____
- Oral steroids or other asthma medicine
Although inhaled medicines work best for asthma, some
children also need to take medicines by mouth. Your
child's oral medicine is ______________________. Give
_____________________ every ______ hours for _____ days.
- Continuous asthma medicine
Most children with asthma need medicines only during
asthma attacks. Children with the following symptoms
usually need daily asthma medicines to allow them to
engage in normal activities:
- three or more attacks of wheezing per week
- asthma flareups lasting several days
- the need for emergency room care despite proper use
of an inhaler
- asthma triggered by pollens (use daily asthma
medicines during the entire pollen season).
When Asthma Medicines Should Be Taken
- Wheezing. If you have any doubt about whether or not your
child is wheezing, have your child start taking his
asthma medicine. The later medicines are begun, the
longer it takes to stop the wheezing. Once treatment
with the medicines is begun, keep your child on the
medicine until he has not wheezed or coughed for 48
hours. (Your child should be kept on the medicine at
for at least 7 days.)
- Colds. Many children wheeze soon after they get coughs and
colds. Start the asthma inhaler or oral medicine at the
first sign of any coughing, shortness of breath, or
wheezing. The best "cough medicine" for a child with
asthma is an asthma medicine, not a cough syrup. Always
keep the medicine handy and take it with you on trips.
If your supply runs low, get a refill.
- Peak flow meters. The most reliable way to detect the
start of an asthma attack is by using a peak flow meter
(PFM), which can measure the air flow out of the lungs.
Peak flow meters measure how fast your child can move air
out of the lungs. Every child over age 6 should use a
PFM. These measurements will tell you when to increase
medications (flow rate less than 80% of baseline, or your
personal best) and when to see a doctor immediately (less
than 50% of baseline).
Other Treatment Guidelines
Drinking fluids keeps the lung mucus from becoming
sticky. Encourage your child to drink enough fluid.
Clear fluids such as water are best. Excessive fluid
intake is not necessary. If your child is not getting
enough fluid he will have dark-colored urine.
- Exercise-induced asthma
Exercise can trigger asthma. Most people with asthma
also get 10- to 15-minute attacks of coughing and
wheezing when they exercise strenuously. Running,
especially in cold air or polluted air, is the main
This problem should not interfere with participation in
most sports nor require a gym excuse. The symptoms can
be prevented by using an inhaler 10 minutes before
exercise. Children with asthma usually have no problems
with swimming or sports not requiring rapid breathing.
- Hay fever
For hay fever symptoms, it's OK to give antihistamines.
Poor control of hay fever can make asthma attacks worse.
Recent research has shown that while antihistamines can
dry the airway, they don't make asthma worse.
- Going to school
Asthma is not contagious. Your child should go to
school during mild asthma attacks but avoid gym or
sports on these days. Arrange to have the asthma
medicines available at school. If your child uses an
inhaler, he should be permitted to keep it with him so
he can use it whenever he needs it.
If your child can't go to school because of asthma, he
should see a physician that same day for additional
- Common mistakes
The most common mistake is delaying the start of
prescribed asthma medicines or not replacing them when
they run out. Nonprescription inhalers and medicines
are not helpful.
The most serious error is continuing to expose your
child to an avoidable cause of asthma. Never keep a cat
if your child is allergic to it. Never allow smoking in
your home; tobacco smoke can linger in the air for up to
Don't panic during asthma attacks. Fear can make tight
breathing worse, so try to remain calm and reassuring to
Finally, don't let asthma restrict your child's
activities, sports, or social life.
- For pain or fever over 102ƒF (39ƒC) give _________________________________
Prevention by Avoiding Asthma Triggers
Try to discover and avoid the substances that trigger your
child's asthma attacks. Tobacco smoke is the biggest
offender. If someone in your household smokes, your child
will have more asthma attacks, take more medication, and
need more emergency room visits. Try to keep pets outside
or at least out of your child's room. Indoor pets need a
weekly bath to remove allergic particles. Learn how to
dustproof your child's bedroom. Change the filters on your
hot-air heating system or air conditioner monthly. For
allergies to molds or carpet dust mites, try to keep the
house humidity less than 50%. Consider using a
If your child wheezes after contact with grass, pollen,
weeds, or animals, pollen or animal dander remaining in the
hair and clothing may keep the wheezing going. Your child
should shower, wash his hair, and put on clean clothes.
Follow-Up Appointment after Discharge
___ Your child needs to be rechecked and has an appointment
on _____________ at _______ with
___ Your child needs to be rechecked in ________ days. Call
your child's doctor to make an appointment.
___ A follow-up appointment is not necessary. Call the
doctor if you have any concerns.
Call Your Child's Physician Immediately If:
- The wheezing becomes severe.
- Breathing becomes difficult or tight.
- Your child needs to use the inhaler more than every
- The peak flow rate is less than 50% of the baseline level
Call Your Child's Physician During Office Hours If:
- The wheezing is not completely gone in 5 days.
- You have other questions or concerns.
For a book list see:
Asthma: Book List
Mothers of Asthmatics, Inc.
10875 Maine Street, Suite 210
Fairfax, Virginia 22030