These pathophysiologic changes cause distal alveoli to trap air and become hyperinflated. As the amount of hyperinflated lung tissue expands, the child’s diaphragm is progressively flattened, causing a mechanical disruption of ventilation. Increased workload for ventilation is transferred onto smaller and weaker intercostal and suprasternal muscles, leading to rapid fatigue and onset of respiratory failure. Breathing isn’t something most people think about but, for some, it doesn’t come naturally. Knowing your child has asthma is the first step to dealing with it. Dr. Michael Marcus discusses what to look out for and what to do about it. Intravenous magnesium has been noted to produce good bronchodilation effects with pediatric patients in status asthmaticus. It is dosed at 50 mg/kg. Common side effects include skin flushing and hypotension, which is rarely clinically significant and responds well to fluid administration.

Learn how to assess, monitor and manage pediatric asthma emergencies, as well as underlying pathophysiologic changes

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It is difficult to match an asthma patient’s hyperventilation, and lower tidal volumes should be used to avoid barotrauma in the setting of hyperinflation. Finally, intravenous ketamine at doses starting at 2 mg/kg, is gaining favor as an adjunctive bronchodilator, especially for agitated patients in respiratory distress [8]. References First, the smooth muscle surrounding the bronchioles is stimulated by histamine and leukotriene, causing bronchoconstriction. Prior ED visits or hospitalizations for asthma (including intensive care unit admissions and/or intubations) Dr Michael Marcus: It’s a common question that I get and weather conditions by themselves really don’t affect asthma other than cold, dry air being a significant trigger for wheezing in patients with asthma. The thing about weather conditions and the thing about moving to different climates is much more related to the things that grow. And so, if you’re in the northeast, you have a certain type of pollen from the grass and the trees and the weeds that are common. If you move to someplace like Arizona, which is more hot and dry, the foliage and pollen in that area is very different. And so, if you hadn’t been exposed to that yet, you won’t have allergies to those things yet. But if you continue in those environments for a long period of time, eventually you develop allergies to those things and eventually the asthma symptoms return. Physically, the patient appears to be in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a respiratory rate of 40/minute, heart rate of 120/minute, and pulse oximetry of 93% on room air. Lung exam is notable for diffuse inspiratory and expiratory bilateral wheezing, poor air movement and a prolonged expiratory phase. The remainder of the examination is unremarkable. Case discussion – Asthma pathophysiology

Joey Wahler (Host): Asthma is a condition that adversely affects breathing, so we’re discussing pediatric asthma and how it’s treated. This is Maimo Med Talk. Thanks for listening. I’m Joey Wahler.

Finally, fluid shifts into the walls of the lower airway, resulting in inflammation and a decrease in airway diameter. The net result is a narrowing of the small airways with increased resistance to airflow.

Once the EMS professional concludes that the most likely diagnosis is an asthma exacerbation, treatment centers around reversing bronchoconstriction and airway inflammation, correcting hypoxemia, rehydration and monitoring for complications – such as pneumothorax.The addition of ipratropium bromide (0.5 mg per dose) to albuterol has been shown to influence a child’s outcome positively. The combination of ipratropium bromide and albuterol may be repeated, as needed, for persistent respiratory distress [3-7]. Joey Wahler (Host): Interesting. How about weather conditions, doctor? What impact might living in a warmer climate have on an asthmatic patient? EMS responds to a residence for a seven-year-old male with a cough and trouble breathing. This episode began two hours ago and has been accompanied by a runny nose without any other symptoms. His mother has been treating him with albuterol by a nebulizer, but he has progressively become more short of breath. Past medical history is notable for asthma since infancy, with multiple prior hospitalizations. Dylla L, Acquisto NM, Manzo F, Cushman JT. Dexamethasone-Related Perineal Burning in the Prehospital Setting: A Case Series. Prehosp Emerg Care. 2018 Sep-Oct;22(5):655-658.

Secondly, mucous glands and cells that line the lower airway are stimulated to secrete excessive mucous, which plugs the bronchioles. Secondly, if a child has asthma, identify how severe the problem is with the help of a physician, and then decide whether the child can use medicine on an as needed basis, triggering only the symptoms of the disease or whether they’ve crossed that threshold of severity and they need daily prevention therapy. Mechanical ventilation may be necessary in rare cases. Non-invasive ventilation with bi-level positive airway pressure can help stave off intubation and preserves the conscious patient’s respiratory drive. Intubation and mechanical ventilation are the last resort for patients with refractory respiratory failure and/or respiratory arrest.The child with status asthmaticus presents with air hunger. Because of the profound bronchoconstriction and minimal airflow through the bronchioles, wheezing is either faint or completely absent. Oxygen saturation levels often reflect severe hypoxia, with readings well below 90%. As hypoxemia worsens, the workload on the ventricles of the heart increases, and the child becomes profoundly acidotic from associated hypercarbia. Pediatric asthma interventions and management Joey Wahler (Host): So how common is pediatric asthma? And is it any more or less prevalent than in years past? Joey Wahler (Host): Wow, what a great story and makes me wonder in closing here, when you’re able to impact lives like that, and I’m sure you’ve done so many times over since, how rewarding is that for you?