It Ain't Easy Being Wheezy T-Shirt - Funny Asthma Inhaler

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Status asthmaticus is a life-threatening condition of progressively-worsening bronchospasm and respiratory dysfunction due to asthma that is unresponsive to conventional therapy. It typically progresses into respiratory failure or arrest and requires aggressive ventilatory and pharmacological interventions. Breathing isn’t something most people think about but, for some, it doesn’t come naturally. Knowing your child has asthma is the first step to dealing with it. Dr. Michael Marcus discusses what to look out for and what to do about it.

The key here is that if we use daily prevention therapy properly, then we decrease the risk that the asthma will become more severe with age and give children the best opportunity to have the healthiest life. If we delay using the prevention therapy and continue to treat asthma on an as needed basis, treating only the symptoms, then we miss the opportunity of preventing progressive damage and limiting the severity of asthma over time. Dr Michael Marcus: There are two approaches that are important to take. One is to identify the triggers as best as possible. I do allergy testing, monitor the patient’s response in different environments and to different foods, so that if we can identify the triggers for their asthma and are able to avoid those triggers, we can decrease the risk of symptoms being set off. If a child is allergic to cats, for example, you certainly would rather not have a cat in the house and you definitely do want the cat in the child’s room ever. That’s just one example. First, the smooth muscle surrounding the bronchioles is stimulated by histamine and leukotriene, causing bronchoconstriction. Once the EMS professional concludes that the most likely diagnosis is an asthma exacerbation, treatment centers around reversing bronchoconstriction and airway inflammation, correcting hypoxemia, rehydration and monitoring for complications – such as pneumothorax.Finally, fluid shifts into the walls of the lower airway, resulting in inflammation and a decrease in airway diameter. The net result is a narrowing of the small airways with increased resistance to airflow. It is difficult to match an asthma patient’s hyperventilation, and lower tidal volumes should be used to avoid barotrauma in the setting of hyperinflation. Finally, intravenous ketamine at doses starting at 2 mg/kg, is gaining favor as an adjunctive bronchodilator, especially for agitated patients in respiratory distress [8]. References Joey Wahler (Host): Asthma is a condition that adversely affects breathing, so we’re discussing pediatric asthma and how it’s treated. This is Maimo Med Talk. Thanks for listening. I’m Joey Wahler. Dylla L, Acquisto NM, Manzo F, Cushman JT. Dexamethasone-Related Perineal Burning in the Prehospital Setting: A Case Series. Prehosp Emerg Care. 2018 Sep-Oct;22(5):655-658. For critically ill children, several other adjunctive therapies may be considered. Early administration of corticosteroids in addition to inhaled beta 2 agonists is recommended, typically at a dose of 2 mg/kg. Intravenous epinephrine rapidly relaxes bronchial smooth muscles and is dosed at 1.0 mL of 1:10,000 concentration, administered over one minute.

Joey Wahler (Host): So how common is pediatric asthma? And is it any more or less prevalent than in years past? Dr Michael Marcus: It’s interesting, but roaches and mice both produce a potent protein that can trigger the same type of inflammatory reaction that leads to the symptoms of asthma. And so early and high concentration of exposure to those things will give a child greater symptoms of their asthma conditions. The addition of ipratropium bromide (0.5 mg per dose) to albuterol has been shown to influence a child’s outcome positively. The combination of ipratropium bromide and albuterol may be repeated, as needed, for persistent respiratory distress [3-7]. EMS professionals need to keep in mind that a child’s lower airway anatomy is proportionally smaller than an adult’s, and is easily compromised from a lesser degree of swelling and constriction. In response to one of the events mentioned earlier, a series of reactions occur in the lower airway. Dr Michael Marcus: It depends on the definition you use. The numbers say that probably about 10% of children will have some form of repeated episodes of wheezing and could be diagnosed as asthma. If you have a family history of asthma, there’s about a 30% chance that you’re going to develop asthma, as opposed to just the general population where that number’s about 10%.

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Secondly, mucous glands and cells that line the lower airway are stimulated to secrete excessive mucous, which plugs the bronchioles. Learn how to assess, monitor and manage pediatric asthma emergencies, as well as underlying pathophysiologic changes Mechanical ventilation may be necessary in rare cases. Non-invasive ventilation with bi-level positive airway pressure can help stave off intubation and preserves the conscious patient’s respiratory drive. Intubation and mechanical ventilation are the last resort for patients with refractory respiratory failure and/or respiratory arrest. Joey Wahler (Host): Aha. So actually it’s not necessarily warmer climate as much as colder, dryer climate, which most people probably would not think is the case. Okay. So how about treating pediatric asthma. What are the common treatments?