Home Care for an Asthmatic Child

¶ … Pathophysiology Asthma is a respiratory tract disease reported to afflict about 300 million persons worldwide and is projected to increase (CCHMC, 2010). It is characterized by chronic and recurring inflammation and obstruction of the airways, expressed by wheezing or coughing. It was reported to be the leading chronic ailment among children (AsthmaCure, 2010). About 50% of cases subside when these children reach age 13 or 14. In the meantime, those who are stricken must contend with current knowledge that symptoms remain totally incurable.

Nonetheless, these can be substantially controlled with adequate and proper education, treatment and management plan set up by a supervising physician. An important part of the success is sufficient knowledge about the disease and faithful adherence to the treatment and management plan (AsthmaCure). Discharge and Education Plan This includes the treatment plan itself and the correct use of the nebulizer and metered dose inhaler for home use by the child (Kovesi et al., 2010). It contains all necessary information on when the child must be rushed to the emergency department.

A recent study found that a single visit at the emergency department may make future unscheduled visits unnecessary. It also recommended a follow-up many days later with a primary care physician or asthma specialist within 4-8 weeks to evaluate the entire therapy management and maintenance dose, especially if it includes regular use of inhaled corticosteroids (Kovesi et al.). A major part of the plan is the administering of the prescribed oral corticosteroids in combination with the inhaled mode to prevent more exacerbations (Pollart et al., 2011).

These exacerbations may be mild, moderate, severe or fatal, according to symptoms, physical findings and other criteria (CCHMC, 2010). These criteria include lung function and saturation of oxygen. Oral corticosteroids are usually given for a week to 10 days, but a regimen of 1 mg per kg of prednisone for 3 days has been shown to be as effective for 5 days in completely containing symptoms within a week for children aged 2-15, which include the six-year-old in the case study (Pollart et al., CCHMC).

In combination, the boy will be given 2-6 inhalations of beta2 agonists at 20-minute intervals and then re-evaluated (CCHMC, 2010). A hand-held metered dose with a spacer device may be used on the child. The aim is to correct severe hypoxemia, quickly reverse airflow obstruction and minimize the risk of relapse. Inhaled corticosteroids have proven effective in managing persistent asthma (Kovesi et al., 2010).

They will be given to the boy every day and between exacerbations as a minimum regimen for a given duration at four puffs per dose in children one year and older. Home-made spacers may also be used as effective substitutes. These include plastic bottles, foam or paper cups, cardboard tubes or paper spacers. Their effectiveness has been beyond question when used correctly and adequately, so that in case of failure, a diagnosis of asthma or another illness should be reconsidered.

In cases when the control of symptoms remains inadequate with the application of moderate dose of inhaled corticosteroids, the dose should be increased or a receptor antagonist introduced. Should he need additional therapy, a pediatric asthma specialist will be consulted (Kovesi et al.). Inhaled steroids must be regularly administered for a given duration and not only during.