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ASTHMA IN CHILDREN
BY EMILY THEMBACHAKO, PEMPHERO NGULUWE, DOREEN GWAZENI,
ELIZABETH HARA

BROAD OBJECTIVE
• By the end of the presentation, participants should gain adequate
knowledge, skills and appropriate attitude in management of asthma
in children

Specific Objective
• Define asthma
• Mention the predisposing factors of asthma
• Describe the pathophysiology of asthma
• Discuss the clinical manifestation of asthma in children
• Describe the medical management of children in asthma
• Discuss the nursing management of asthma in children
• Explain the education given to child and parents

Definition of asthma
• Asthma is a chronic inflammatory obstructive disease of the airway
• It is characterised by being recurrent triad symptoms of bronchial
smooth muscle spasm, inflammation and edema of bronchial; mucosa
and production and retention of thick pulmonary secretion leading to
airway obstruction

Predisposing factors
• Hereditary
• Colds and infection
• Allegerns ie pollen, weeds air pollution
• Irritants: perfumes, odors
• Medications such as aspirin
• Food , exercise, emotions

pathophysiology
• Asthma is an inflammation of the airway which is present throughout
the bronchial tree
• Presence of predisposing factors causes inflammation of the airways
• The inflammation is characterised by mast cell activation, edema and
disruption of the epithelium
• The inflammation contributes to hypersensitivity of airway, airflow
limitation
• There is presence of bronchial obstruction due to spasms of the
smooth muscles

Pathophysiology of asthma
• There is increased bronchial secretion which end up blocking the
airway
• There is swelling of membranes (mucosal edema),
• The narrowing leads to obstruction therefore making the child
hypoventilated and hypofused

ASTHMA_IN_CHILDREN for NURSING STUDENT[1].pptx

Diagnostic studies
• Full blood count shows elevated WBC
• Chest exray shows hypoinfiltration to the lungs

Types of asthma
• Mild asthma : child may have audible wheezes, no signs of respiratory
distress , feeding well have a oxygen saturation of above 92%
• Moderate asthma: child may have respiratory distress, use of
accessory muscles, feeding well, oxygen saturation of above 92%
• Severe asthma : there is a marked respiratory distress, child is too
breathless to talk or to feed, oxygen saturation of below
92%,respiratory rate greater than 30beats per minute in children
above 5 and 50beats per minute in children who are 2 to 5 years

Clinical manifestation
• Cough especially at night
• Wheezing
• Dyspnea
• Cyanosis
• Use of accessory muscles
• Exhaustion
• Tachypnea

Medical management
• Severe asthma
• Call for help
• Give oxygen 1 to 2 litres per minute
• Salbutamol by nebulisers 2.5mg if less than 3years and 5mg if greater
than 3years
• Hydrocortisone 4mg per kg iv
• Dexamethasone 0.3mg per kg IM
• If no improvement after 30 minutes give aminophylline 5mg per kg
slow IV, too fat can cause fits, vomiting headache cardiac arrhythmias

Severe asthma
• Repeat aminophylline 5mg slow IV 6 hourly or slow infusion
• Repeat hydrocortisone 6hourly if child cannot swallow
• And give predinisolone if able to swallow

Moderate asthma mgt
• Salbutamol or albuterol inhaler via spacer or facemask if less than
3years
• If < 4years, 5 puffs every 20 minutes
• If >4years 10 puffs every 20 minutes
• Prednisolone 1mg per kg maximum of 30mg OD for 3 days

Mild asthma
• Salbutamol or albeterol through a spacer , 2 puffs 4hourlybfor 2 to 3
days
• Teach on use of spacer
• Return if not improving

Nursing diagnosis
• Ineffective breathing pattern related to increased airway resistance
secondary to bronchospasm, mucosal edema as evidenced by
dyspnea
• Ineffective airway clearance related to inflammatory reaction as
evidenced by a noisy breathing
• Activity intolerance related to imbalance between oxygen supply and
demand as evidenced by fatigue

Nursing intervention
• Assess child ABCCCD
• Monitor vital signs
• Position child in high fowlers to promote lung expansion
• Provide humidified oxygen
• Encourage deep breathing exercises
• Administer bronchodilators
• Help child with chest physiotherapy
• Allow child to rest by planning activities

Nursing management
• Encourage breastfeeding or oral fluid intake
• Encourage complimentary feeding if child is able to orally take food

Education
• Child and the guardian should be educated on the following
• Disease process
• Use of medication
• Preventing allergens, drugs or food that cause asthma attacks
• Use of inhaler

REFERENCE
• Electronic protocols of the management of childhood illness in
Malawi
• London, M.L, Ladewing, P.W, Ball, J.W & Bindlerm R.C (2020).
Maternal child nursing care: optimizing outcomes for mothers,
children and families
• Kazembe P.N & Phillips J.A, Peadiatric handbook for Malawi, 3rd
edition, montford press
• Malawi standard treatment guideline

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