Asthma is the most common chronic disease in childhood due mainly to changes in our living conditions and family environment. An asthma attack is an episode of shortness of breath with coughing, wheezing (whistling or whistling in the chest), fatigue and chest tightness. The cause is a decrease in airflow due to bronchial obstruction and inflammation. Asthma attacks cause a great physical and emotional impact on the patient and his family.
The onset of an asthma attack can be rapid or slow.
- Rapid asthma is characterized by a predominance of bronchoconstriction, greater initial severity and a faster and more favorable response to treatment. It is caused by aeroallergens, allergens and food additives, drugs, air pollutants, physical exercise, stress, cold or humidity.
- Slow asthma is characterized by a predominance of inflammation, a poorer response to treatment and is caused by respiratory viral infections or poorly controlled or inadequately treated asthma.
- Children with asthma who live with smokers have asthma attacks more often, are more severe, more difficult to control and require more medication.
Symptoms and types of bronchial asthma
To assess the severity of an asthma attack, the state of consciousness, the presence of dyspnea and shortness of breath, respiratory auscultation, respiratory and heart rate and oxygen saturation should be examined.
- For example, in a mild crisis the child has normal consciousness, speaks in normal sentences, has dyspnea when walking, but does not have a shortness of breath. On auscultation, moderate wheezing is heard, respiratory rate is less than 20 – 30 breaths per minute (depending on age), heart rate is less than 100 beats per minute, at all ages, and oxygen saturation is equal to or greater than 95%.
- However, in a severe crisis the child presents with agitation, drowsiness or confusion, slurred speech, difficulty eating, dyspnea at rest and severe tugging. On auscultation, intense wheezing is heard, respiratory rate is greater than 25 – 50 breaths per minute and cardiac rate is greater than 120 – 130 beats per minute, depending on age, and oxygen saturation is less than 92%.
- The risk factors for suffering a life-threatening asthma attack are: previous history of admission to the Intensive Care Unit, two or more admissions in the last year, multiple visits to the Emergency Department in the previous year, cardiovascular disease, abuse of bronchodilator drugs, sudden onset of the attack and absence of periodic controls of the disease.
Treatment of an asthma attack
The treatment of an asthma attack is mainly based on the administration of bronchodilators and systemic corticosteroids. Early use of oxygen is recommended when saturation is less than 94% and in life-threatening asthma.
- For bronchodilators, the route of administration of choice is inhalation due to its greater effectiveness, rapidity of action and fewer side effects. The pressurized inhaler system with spacer chamber is as effective, if not more effective, than nebulizers and is recommended for all ages. The nebulizer system should be reserved when oxygen delivery is required in severe seizures. Doses depend on the severity of the seizures and the response to initial doses.
- Systemic corticosteroids are administered orally. Their early use, during the first hour of the crisis, reduces hospitalization. They are given in batches of 3-5 days and can be discontinued without gradual dose reduction. Their use results in fewer relapses, fewer consultations and less use of bronchodilators. They are especially indicated in moderate and severe crises, in mild crises requiring bronchodilators before 3 or 4 hours and in life-threatening asthma.
- After resolution of the crisis the pediatrician should assess the asthma, prescribe maintenance treatment, schedule regular check-ups, monitor adherence to treatment and inhalation technique, study triggers and implement a symptom-based action plan and educational intervention.