Asthma in Early Childhood

What is Asthma? https://www.youtube.com/watch?v=PzfLDi-sL3w

Asthma is a medical condition that causes narrowing of the small airways in the lungs. Typically, asthma sufferers develop wheezing and have increased mucus production in their lungs. Asthma sufferers often have the disease for many years. The episodes of shortness of breath may be life threatening and often triggered by allergic reactions.
Bronchial asthma is another name for the common form of asthma. The term ‘bronchial’ is occasionally used to differentiate it from what doctors call ‘cardiac’ asthma, which is not true asthma but breathing difficulties caused by heart failure. Although the two conditions have similar symptoms, including shortness of breath and wheezing (a whistling sound in the chest), they have quite different treatments.
People with asthma have sensitive airways in their lungs which can narrow when exposed to certain ‘triggers’ leading to difficulty in breathing.
Three main factors cause the airways to narrow:
  • The muscle around the airway tightens (bronchoconstriction).
  • The inside lining of the airways becomes swollen (inflammation).
  • Extra mucus (sticky fluid) may be produced.

What are Asthma Triggers?

A trigger is something that causes your airways to narrow, leading to asthma symptoms. Everyone’s asthma is different, and everyone has different triggers are only a problem when their asthma is not well controlled.

Allergic versus Non-Allergic Triggers

Some asthma triggers are a response to an allergic reaction.An allergic reaction is a complex chain of events that involves many cells, chemicals and tissues in your body. It results in inflammation in the skin, lungs, gut, nose and/or eyes. This may cause symptoms such as swelling, redness and itch in the skin; watery, itchy nose with sneezing and blockage; watery, red itchy eyes; wheezing, coughing and mucus production in the lungs. This reaction begins when a person who is allergic comes into contact with the allergen “invader” to which they are sensitive.

Asthma symptoms can occur when an allergen is breathed into the lungs of a sensitive person. This leads to swelling of the lining of the airways and tightening of the muscles around the airway which causes narrowing of the airway and therefore difficulty in breathing.

Allergens are common asthma triggers, however not all asthma is caused by allergy and not all
allergies lead to asthma.

Common Allergic Triggers
Pollens: from trees, grasses, weeds etc.
Vermin: faeces/saliva from cockroaches, mice etc.
Dust: Dust mites, and wood/grain
Moulds
Pet/animal dander (skin flakes in an animal’s fur or hair); pet urine, saliva, faeces
Foods: Nuts, soy, shellfish, milk and some proteins
Natural oils/fragrances; perfumes, cleaning products, citrus, animal fats and oils, plant extracts, chemicals
Certain drugs/medications; asprin and some blood pressure control medication
Cigarette smoke; is directly harmful the airways and makes asthma worse, so exposure to cigarette smoke            should be avoided by anyone who has asthma.

Common Non-Allergic Triggers

Emotion
Anxiety, depression
Stress
Exercise
Cold air
Dry
Respiratory infection, colds and flu
Gastro-intestinal reflux
Temperature change

Asthma in Children -in Early Childhood

Children at Risk

Asthma is the most common chronic disease among children – especially children who have low birth weight, are exposed to tobacco smoke, are raised in a low-income environment. Most children first present symptoms around 5 years of age, generally beginning as frequent episodes of wheezing with respiratory infections. Additional risk factors for children include having allergies, the allergic skin condition eczema, or parents with asthma.

Young boys are more likely to develop asthma than young girls, but this trend reverses during adulthood. Researchers hypothesize that this is due to the smaller size of a young male’s airway compared to a young female’s airway, leading to a higher risk of wheezing after a viral infection.

Asthma in Young Children in Childcare facilities

Asthma affects more than 1 in 9 children in Australia, and many of these children attend care services every day. Child care services and staff can work together with parents and carers to provide a healthy and safe care environment for children with asthma.

Whose Responsibility is it?

Responsibility for the management of a child’s asthma is shared.

Parents Should:

    • Tell the service that your child has asthma and give them a written Asthma Action Plan or similar as required.
    • Provide sufficient information and equipment to staff to allow them to support the child while in care.
    • Advise if there has been a change in the child’s health, or in their medical management.
    • Ensure that your child has reliever medication with them every day, and preferably a spacer is used. The medication must not have expired and should contain plenty of doses. Also ensure that the medication is labelled clearly with your child’s name.
    • Make sure you let the service know if your child has been unwell with asthma symptoms.
  • Aim for good asthma management at home by taking your child regularly for asthma reviews with their doctor, and then following medical advice on taking medication.
  • Centres Should:
    • Encourage parents to provide up to date information about their child with asthma, and keep this information in a known, central location.
    • Ensure all staff are aware of which children in their care have asthma.
    • Enable and encourage staff to attend training and obtain information about asthma and how to manage an asthma emergency.
    • Ensure the service has sufficient Asthma Emergency Kits, staff are aware of the locations and they are easily accessible (dates and contents of kits need to be regularly checked and updated accordingly).
    • Have Asthma First Aid Posters displayed around the centre.
    • Have policies that support the staff to act appropriately and effectively in an asthma emergency, including during off-site activities.
    • Allow staff access to reliever medication at all times, so that prompt action can be taken in an asthma emergency.
  • Communicate any concerns regarding a child’s asthma to the family.
  • Staff Should:
    • Check that they know which children in their care have asthma.
    • Be familiar with the service’s asthma policy.
    • Attend training sessions on asthma and know how to recognise and respond to an asthma emergency.
    • Know the location of Asthma Emergency Kits and ensure that they take one with them if travelling offsite with children.
    • Document the use of medication according to service guidelines.
    • Inform family and/or service management of any concerns regarding a child’s asthma.

(Reference: Asthma Foundation n.d.)

Asthma – Medication and Equipment

The most effective way of taking most asthma medicines is to inhale them straight into your lungs. Your doctor will have prescribed you an inhaler or inhalers. There are two main inhaler medicines:

Spacers

A spacer is a plastic or metal container with a mouthpiece at one end and a hole for the aerosol inhaler at the other. Spacers only work with an aerosol inhaler. Spacers are important because they help to deliver the medicine straight to the lungs. They also make the inhaler easier to use and reduce the risk of side effects.

The first aider places the spacer mouthpiece in the casualty’s mouth, ensuring a good seal and no air leakage, administers one puff into the spacer and asks the casualty to breathe in and out normally for 4 breaths, once again checking the seal between the mouthpiece and the spacer. The first aider replaces the cap on the aerosol inhaler.

Relievers

Everyone with asthma should have a reliever aerosol inhaler. They are usually blue or grey in colour and the drug of choice is salbutamol, however this may be known by different brand names including asmol or aerolin. Reliever medications work as bronchodilators. That means that they relax the muscle around your airways, making the passages themselves wider. Because their fast action provides relief almost straight away, they are used as the ‘first aid’ treatment for asthma symptoms. Asthma sufferers should take this immediately to relieve asthma symptoms and carry it with them at all times. Relievers are essential in treating asthma attacks. Other reliever medications other than salbutamol include terbutaline and budesonide. The term aerosol inhaler is often referred to as a ‘puffer’.

Preventers

Preventers are medications that control the swelling and inflammation in the airways that makes it harder for you to breathe, or makes you cough and wheeze. They are usually brown, red or orange in colour. Preventer medications reduce the risk of severe asthma attacks. The protective effect of preventer medications builds up over time, so it is important to take them every day, even when you feel well. A individuals doctor should tell them how much to take and when. They should know exactly when and how to take both their reliever and preventer inhalers. If unsure they should make an appointment to see their doctor who should explain it to them.

Masks (with spacer)

Due to their young age and cognitive ability, children under the age of 4, require inhaled medications to be given using an aerosol inhaler and spacer with a mask. Children aged 4-6 years of age can normally use an inhaler with a spacer without the mask. It is ideal to use the spacer with all children if it is available.

Oxygen

If oxygen is available and the first aider and/or a bystander are trained in its use, it should be administered at a minimum of 8LPM via a mask. If oxygen is being administered, the first aider needs to be mindful of occupational hazards related to oxygen and the environment and/or workplace site, for example, naked flames, fire, vapours and chemicals.

Asthma Signs and Symptoms in Early Childhood

Signs and symptoms can be described or categorised into mild, moderate or severe. Quickly identifying the severity of a casualty’s symptoms can ensure appropriate management and treatment and provide the best outcome for the casualty. For example, calling an ambulance via 000/112, for a casualty that is suffering mild symptoms is inappropriate, and puts other people in the community at risk who require an urgent ambulance.

Mild Asthma

  • Wheezing.
  • Shortness of breath, worsening with exercise.
  • Cough, particularly at night, early morning and with exercise.
  • Chest pain, tightness of the chest.

Moderate Asthma

  • Severe cough.
  • Moderate wheezing, and it occurs at rest.
  • Difficulty breathing, only able to speak short sentences.
  • Chest tightness.
  • Inability to sleep.

Severe Asthma 

  • Gasping for breath.
  • Severe wheezing.
  • Severe difficulty breathing, only able to speak one or two words per breath.
  • Inability to lie down.
  • Drawing in of spaces between the ribs and above the collar bones with the effort of breathing.
  • Severe chest pain/tightness when taking a breath or coughing.
  • Thirst due to loss of water vapour from the lungs as a result of an increased work of breathing.
  • Cyanosis around the lips.
  • Little or no improvement after using a ‘reliever’ medication.
  • Pale, sweaty skin.
  • Increasing pulse rate.
  • Collapse/unresponsive leading to a respiratory arrest.
If you, as the First Aider identify the casualty is having a severe asthma attack, call an ambulance immediately 000/112.

Asthma Action Plan in Early Childhood

An Asthma Action Plan is a written set of instructions prepared by an individual’s doctor or nurse that helps them to stay in control of their asthma. A written Asthma Action Plan outlines:

  • What medication to take every day (even when you are feeling well).
  • How to tell if your asthma is getting worse.
  • What you should do if your symptoms are getting worse.
  • What to do if you have an asthma attack.

Having a written asthma action plan can help to:

    1. Reduce your chance of needing to go to hospital, or for an urgent doctor’s visit.
    2. Improve your lung function.
    3. Reduce the number of days off work or school due to asthma.

Sometimes plans are based on symptoms, while others are based on peak flow score. Each person along with their doctor or nurse can decide together what will work best.

Update your Asthma Action Plan

Asthma Action Plans should be updated regularly by a doctor in conjunction with an asthma review. For most adults, this should be at least once a year, and for children approximately every six months. For those people with more severe asthma, more frequent reviews might be needed.

There are different types of Asthma Action Plans, and you can use whichever one suits you best.

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