We get a lot of parents who hesitate to take their child to the Emergency Department with asthma because they feel when they get there, the child is just given more reliever with the spacer, there’s just a whole lot of waiting and nothing is actually ‘done’. I have to admit, until I understood the process, I thought this too. It’s important for children having asthma flare-ups to receive timely care, so I hope that explaining the process will help a little for others. Here goes.
Asthma management in hospital involves a process of assessment, intervention, monitoring…..repeat. Asthma can go from bad to life-threatening very quickly, so it is important to realise that sitting in the waiting room or the little cubicle with the nurse popping back every so often, is actually part of the treatment. This monitoring ensures that any deterioration is picked up very quickly and dealt with quickly. These are little airways after all! And although it may feel like ‘nothing is happening’, you are in the right place should things get worse, and your child is actually being monitored – which is a very important part of managing asthma.
When a child presents to the emergency department with asthma, there is protocol that the staff follow in order to assess whether the asthma flare-up is mild, moderate or severe. When you first arrive, your child will be triaged. They will pop the pulse oximeter onto their finger to measure how much oxygen is in the blood, how fast the pulse is going and therefore how hard the heart is working. They will look at your child and see whether they are working extra hard to breathe, eg. Are their ribs sucking in and out? Is their throat tugging in and out? Are they distressed? Too breathless to talk? Someone will listen to their chest – are there extra sounds in there that might indicate a chest infection? Is air moving in and out of the chest in a normal way? Is there wheeze? They might take a temperature reading as well.
Based on all this information, a decision is made as to how to progress. If it is mild asthma flare-up the reliever medicine will be given via a spacer (usually in this scenario it would be 1 puff to 6 breaths, 6 times). The doctor will be wanting to see if there is any improvement in symptoms after this. If not, more would be given and monitoring will continue. If there is improvement, then over the next few hours the goal is to increase the time between the doses, until the child can go for at least 2 hours without the reliever. This is called spacing. Depending on their age they may also be given prednisone, a strong steroid to help settle the swelling and inflammation in the airways quickly. If your child can go for two hours in the ED without requiring the reliever, then you may be discharged home.
If the asthma is deemed to be more moderate or severe during triage, then a nebuliser might be used to deliver different types of medicines. If these steps don’t work, then things move along to more intense treatments like medicines injected intravenously, and perhaps even a transfer to the intensive care unit.
You can see that the underlying theme here is monitoring. Monitoring takes a long time to ensure the child is safe, therefore you will probably get to watch a fair few Disney movies on a loop before you are allowed to go home. Settle in. Get comfortable. You are in the right place for the safety of your child.