How to Treat Asthma in Pediatric Patients

Asthma is a predisposition to chronic inflammation of the lungs in which the airways (bronchi) are reversibly constricted. Asthma is more complex in children because the size of the airway is smaller. During a pediatric asthma attack, the smooth muscle cells contract and constrict, the airways become swollen, and breathing becomes difficult.

Things You'll Need

• Peak flow meter
• Lab values (Arterial Blood Gases, CBC, Blood Cultures, and Chemistry Panel)
• Oxygen saturation monitor
• Oxygen
• Metered-dose inhaler
• Fluid replacement
• Steroid medication (IV, injectable, or oral, depending on severity)
• Nebulizer breathing treatment
• Antibiotic (indicated if bacterial infection is present)

Show More

Instructions

• 1

  Measure peak flow to determine the severity of the attack. The indicator on the peak flow meter is like a traffic signal where the green zone is the optimal level, the yellow zone is a warning that the attack is approaching a dangerous level, and the red zone signals a severe attack warranting aggressive treatment.

• 2

  Obtain lab values. Arterial blood gases will reveal oxygen and carbon dioxide levels. A CBC and electrolytes will indicate whether infection is present, or if the child is dehydrated, and needs fluid and electrolyte replacement.

• 3

  Place the child on an SpO2 monitor to measure oxygen saturation. Administer blow-by oxygen, nasal cannula, or hood O2, based on the O2 saturation level. A finding of 88 percent or less will require more aggressive therapy.

• 4

  Administer medications such as metered-dose inhalers (this is inclusive of a rescue inhaler, such as Albuterol, and a topical steroid such as Pulmicort.) For more aggressive treatment requiring hospitalization, intramuscular or IV steroids, such as Solu-Medrol, may be indicated. Nebulizer breathing treatments ordered around the clock will stop status asthmaticus (an acute exacerbation of asthma that may not respond to other treatments). If the blood culture is positive for bacteria versus a virus, then broad-spectrum antibiotics are a necessary adjunct to treatment.

• 5

  Administer fluid replacement to liquify secretions, counteract dehydration, and to replace necessary electrolytes. For mild dehydration, Pedialyte and sports drinks work well, and for more severe dehydration, IV solutions such as D5/LR or 0.9% sodium chloride are ordered along with replacement of vital electrolytes, such as potassium.