Asthma

Adult Asthma (Chronic)

More information coming soon. See information about common asthma myths to discuss when counseling patients.

Adult Asthma Exacerbation

Patient with history of asthma, atopic dermatitis, seasonal allergies, and smoking presents with acute on chronic dyspnea. Exacerbations typically display a seasonal pattern. Reports rhinorrhea as well as recent exposure to cleaning product vaports, second-hand smoke, wood burning stove, pets, cockroaches, and mold. Medications include NSAIDs, beta-blockers, and ACE inhibitors. Tachypnea, retractions, and inspiratory/expiratory wheezes on exam. Cannot count to three in one breath.

Pediatric Asthma (Chronic)

More information coming soon. See information about common asthma myths to discuss when counseling patients.

Pediatric Asthma Exacerbation

Pediatric patient with h/o asthma, atopic dermatitis, and seasonal allergies presents with acute on chronic dyspnea. Exacerbations typically display a seasonal pattern. Parent reports recent rhinorrhea and NSAID administration. Cleaning product vaports, second-hand smoke, wood burning stove, pets, cockroaches, and mold present in home. Tachypnea, head bobbing, nasal flaring, subcostal/intercostal/substernal/supraclavicular retractions, and inspiratory/expiratory wheezes on exam. Cannot count to three in one breath.

• Outpatient

  • Obtain peak flow and compare to baseline

  • Initial respiratory score: If ≤ 5, proceed with treatment in office. Otherwise, refer family to the nearest emergency department.

    • Administer albuterol MDI x 8 puffs

    • Administer dexamethasone 0.6 mg/kg x 1 (maximum 16 mg)

    • Review asthma action plan with parent and child

    • Observe for 1 hour

  • Reassess respiratory score after 1 hour

    • If ≤ 4, return home with appropriate increase in therapy (see Asthma Severity and Associated Therapy above) and follow up in 2 weeks

    • If > 4, refer family to the nearest emergency department

• Emergency Department

  • All patients

    • Start supplemental oxygen to maintain SPO2 > 90%

    • Start albuterol MDI or nebulizer (see below)

    • Administer dexamethasone 0.6 mg/kg x 1 (maximum 16 mg)

  • Respiratory score 6-9: Add ipratropium nebulizer

  • Respiratory score 10-12: Add magnesium sulfate

• Reassess at hours 2, 3, and 4 and adjust therapy and/or admit as indicated below

Notes

• Asthma is more common in patients with a history of atopy, e.g. eczema and seasonal allergies

• Seasonal exacerbations may occur during the spring (pollen/weather change), summer (humidity), fall (weather change), and/or winter (cold)

• Medications that may worsen asthma include NSAIDs, beta-blockers, and ACE inhibitors

• Asthma exacerbation triggers commonly include

  • Respiratory illness

  • Allergen/environmental exposures

    • Smoke/vapors, e.g. smokin, second-hand smoke, wood burning stoves, cleaning products

    • Animals, e.g. household pets and cockroaches

    • Mold in houses, including air conditioning units

• See Asthma Management Pathway from Seattle Children’s Hospital (below) for management and dosing information.