Asthma Attack
Definition
Your child is having an asthma attack
Use this guide only if a doctor has told you your child has asthma
Symptoms of Asthma
Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.
The diagnosis of asthma requires attacks of wheezing that recur. The diagnosis is rarely made before 1 year of age.
Causes (Triggers) of Asthma Attacks
Infections that affect breathing (like colds or the flu)
Pollens (trees, grass and weeds)
Animals (like cats or rabbits)
Tobacco smoke
Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
Food Allergy (Serious). Asthma attacks caused by food allergy can be life-threatening (anaphylaxis). Examples are nuts or fish.
Asthma Attack Scale
Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard or mild. (Green Zone: Peak Flow Rate 80-100% of normal rate)
Moderate: SOB at rest. Speaks in phrases. Wants to sit (can't lay down flat). Wheezing can be heard. Retractions are present (ribs pull in with each breath). (Yellow Zone: Peak Flow Rate 50-80% of normal rate)
Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. Rarely, wheezing is absent due to poor air movement. Retractions may be severe. (Red Zone: Peak Flow Rate less than 50% of normal rate)
Peak Flow Meter: a peak flow meter measures Peak Flow Rates (PFR). It tells us how well a person can move air out of the lungs. A PFR can be used in children 6 years and older.
When To Call
Call 911 Now
Wheezing and life-threatening allergic reaction to similar substance in the past
Start to wheeze suddenly after a bee sting, taking medicine, or eating an allergic food
Severe trouble breathing (struggling for each breath, can barely speak or cry)
Passed out
Lips or face are bluish when not coughing
You think your child has a life-threatening emergency
Go to ER Now
Looks like he did when hospitalized before with asthma
Trouble breathing not gone 20 minutes after neb or inhaler
Peak flow rate less than 50% of normal rate (Red Zone)
Call Doctor or Seek Care Now
Pulse oxygen level less than 90% during asthma attack
Lips or face have turned bluish during coughing
Ribs are pulling in with each breath (retractions)
PEFR is 50-80% of normal rate after using nebulizer or inhaler (Yellow Zone)
Wheezing not gone 20 minutes after using neb or inhaler
Breathing is much faster than normal
Nonstop coughing not better after using nebulizer or inhaler
Severe chest pain
Need to use asthma medicine (neb or inhaler) more often than every 4 hours
Fever over 104° F (40° C)
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
Mild wheezing lasts more than 24 hours on neb or inhaler treatments
Sinus pain (not just congestion)
Fever lasts more than 3 days
Fever returns after being gone more than 24 hours
You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
Don't have written asthma action plan from your doctor
Use an inhaler, but don't have a spacer
Miss more than 1 day of school per month for asthma
Asthma limits exercise or sports
Asthma attacks wake child up from sleep
Use more than 1 inhaler per month
No asthma check-up in more than 1 year
You have other questions or concerns
Self Care at Home
Mild asthma attack
Care Advice
What You Should Know About Asthma:
Over 10% of children have asthma.
Your child's asthma can flare up at any time.
When you are away from your home, always take your child's medicines with you.
The sooner you start treatment, the faster your child will feel better.
Here is some care advice that should help.
Asthma Quick-Relief Medicine:
Your child's quick-relief (rescue) medicine is albuterol or xopenex.
Start it at the first sign of any wheezing, shortness of breath or hard coughing.
Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
Repeat it every 4 hours if your child is having any asthma symptoms.
Never give it more often than 4 hours without talking with your child's doctor.
Coughing. The best "cough med" for a child with asthma is always the asthma medicine. Caution: Don't use cough suppressants. If over 6 years old, cough drops may help a tickly cough.
Caution: If the inhaler hasn't been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
Use the medicine until your child has not wheezed or coughed for 48 hours.
Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.
Asthma Controller Medicine:
Your child may have been told to use a controller drug. An example is an inhaled steroid.
It's for preventing attacks and must be used daily.
During asthma attacks, keep giving this medicine to your child as ordered.
Allergy Medicine for Hay Fever:
For signs of nasal allergies (hay fever), it's okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.
Fluids - Offer More:
Try to get your child to drink lots of fluids.
Goal: Keep your child well hydrated.
Reason: It will loosen up any phlegm in the lungs. Then it's easier to cough up.
Humidifier:
If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
Avoid Tobacco Smoke:
Tobacco smoke makes asthma much worse.
Don't let anyone smoke around your child.
Avoid or Remove Triggers:
Shower to remove pollens or other allergens from the body and hair.
Avoid known causes of asthma attacks (such as smoke or cats).
During attacks, reduce exercise or sports if it makes your child's asthma worse.
What to Expect:
If treatment is started early, most asthma attacks are quickly brought under control.
All wheezing should be gone by 5 days.
Inhaler With a Spacer: How to Use
Step 1. Shake the inhaler well. Then attach it to the spacer (holding chamber).
Step 2. Breathe out completely and empty the lungs.
Step 3. Close the lips and teeth around the spacer mouthpiece.
Step 4. Press down on the inhaler. This will put one puff of the medicine in the spacer.
Step 5. Breathe in slowly until the lungs are full.
Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
Metered Dose Inhaler (MDI): How to Use Without a Spacer (if you don't have one)
Step 1. Shake the inhaler well.
Step 2. Breathe out completely and empty the lungs.
Step 3. Close the lips and teeth around the inhaler mouthpiece.
Step 4. Press down on the inhaler to release a puff. Do this just as your child starts to breathe in.
Step 5. Breathe in slowly until the lungs are full.
Step 6. Hold a deep breath for 10 seconds. Allow the medicine to work deep in the lungs.
If your doctor has ordered 2 or more puffs, wait 1 minute. Then repeat steps 1-6.
Ask your doctor for a spacer if you don't have one. It will help send more medicine into the lungs.
Older children who don't like a spacer can be prescribed an albuterol dry powder device.
Home Nebulizer: How to Use:
A nebulizer machine changes a liquid medicine (med) into a fine mist. The fine mist can carry the med deep into the lungs. This is called a nebulizer (neb) treatment.
Step 1. Prepare the medicine. First, wash your hands with soap and water. For pre-mixed single dose vials, just add one vial to the neb holding cup. For multi-dose vials, you need to do the mixing. First, add the correct amount of normal saline to the neb cup. Then carefully measure and add the correct amount of medicine to the saline.
Step 2. Connect the nebulizer to the air compressor tubing. The air compressor is run by electricity. Portable ones run on a battery. Compressors make the jet of air that turns the medicine into a fine mist.
Step 3. Turn on the air compressor. It will start making the fine mist that your child needs.
Step 4 for an Older Child. Place the mouthpiece between your child's teeth and seal with the lips. Ask your child to breathe slowly and deeply. Ask your child to hold a deep breath for 10 seconds once a minute.
Step 4 for a Younger Child. If your child refuses the mouthpiece, use a face mask. It should cover the nose and mouth. It should fit snugly.
Step 5. Continue the treatment until the med is gone. If the med sticks to the side of the cup, shake it a little. An average neb treatment takes 10 minutes.
Step 6. After each treatment, take the nebulizer apart. Rinse and clean it as directed. Reason: It can't produce mist if it becomes clogged up.
Caution: Closely follow your doctor's instructions. Use the exact amount of med your doctor ordered. Don't give a neb treatment more often than every 4 hours.
Call Your Doctor If:
Trouble breathing occurs
Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
Wheezing lasts over 24 hours
You think your child needs to be seen
Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Breath-holding spell
Definition
A spell that involves holding the breath, then turning blue and passing out
Breath-holding spells were diagnosed by your child's doctor
Symptoms of a Breath-Holding Spell
An upsetting event happens right before the spell. A common trigger is being angry about parents setting limits (temper tantrums). Another is getting scared. Some spells are triggered by a sudden injury, such as falling down.
The child gives out 1 or 2 long cries
Then holds his breath until the lips and face become bluish
Then passes out and falls to the floor
Then often becomes stiff. May also have a few muscle jerks.
Normal breathing starts again in less than 1 minute. Becomes fully alert in less than 2 minutes.
Only happens when child is awake, never when asleep
Cause
A reflex response to strong feelings. This reflex allows some children to hold their breath long enough to pass out. Spells do not happen on purpose.
This happens in 5% of healthy children. Breath-holding spells can run in families.
Starts between 6 months and 2 years of age. Goes away by age 6.
Many young children hold their breath when upset, turn blue, but don't pass out. This is common and normal.
Frequent spells can happen in children who have anemia (low red blood count). This can happen if your child doesn't eat enough foods with iron. If your child is a picky eater, your doctor may order a blood test.
When To Call
Call 911 Now
Breathing stopped for more than 1 minute and hasn't returned
You think your child has a life-threatening emergency
Go to ER Now
Trouble breathing after spell ends
Call Doctor or Seek Care Now
Passed out more than 2 minutes by the clock and normal breathing now
First breath-holding spell
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent
Call Doctor During Office Hours
Never been checked by a doctor for the spells
Spells happen without a reason (no triggers)
Muscle jerks during spell
Picky eater (especially for meats)
Lots of tantrums trigger the spells
Spells happen more than once a week
You think your child needs to be seen, but the problem is not urgent
You have other questions or concerns
Self Care at Home
Normal breath-holding spell
Care Advice
What You Should Know About Breath-Holding Spells:
While breath-holding spells are scary for parents, they are harmless.
Normal breathing always returns on its own.
The spells don't lead to seizures (epilepsy).
Here is some care advice that should help.
Lie Down:
During the spell, have your child lie down.
This will increase blood flow to the brain.
Remove any food from his mouth.
Do not hold your child upright. It decreases blood flow to the brain. This could cause some jerking of body muscles.
Cold Washcloth to Forehead:
Put a cold, wet washcloth on your child's forehead. Keep it on until he or she starts breathing again.
That's the only care your child needs.
Time the Length of Not Breathing:
These spells always seem to last longer than they really do.
Time the length of a few spells. Use a watch with a second hand.
Breathing almost always returns by 60 seconds.
It's hard to guess at the length of a spell and get it right.
Stay Calm: