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Asthma and the significance of learning its diagnosis and management in children

Asthma is a respiratory disorder that affects bronchioles making them sensitive to certain triggers, leading to narrowing of airways and difficult breathing. It is a treatable health condition. At present, there is no cure but through an effective management, people suffering from asthma can lead a normal and active life (Cronin, et al. 2016).

The major issue with asthma is that its prevalence among Australian children is highest in the world. It affects almost one in nine children in Australia. According to Growing up in Australia (2009) almost 17% of infants face asthma or wheezing in their early 3 years while 4.1% of non asthmatic children develop asthma by the age of 7. Further, boys are affected more than girls. It has also been found that the children of 0 to 4 years are the ones who are bought to Emergency department or are hospitalised for asthma (Australian Centre for Asthma Monitoring, 2009). Another major concern with this condition is that in most of the cases, it is not correctly diagnosed and therefore, young children and infants fail to receive appropriate treatment. As per Goeman et al. 2012, almost half of the young children go undiagnosed that carries a high risk of long term damage to the airways. Moreover, they are prone to get hospitalised repeatedly or ending up in emergency critical situation (Ducharme et al. 2016).

Therefore, it becomes an essential requirement to educate and train New Graduate registered Nurse about asthma, its diagnosis and effective management. It is easy for nursing students to learn, retain and adjust in early years of training, thus this workbook would educate the New graduate nurses to differentiate asthma symptoms from other respiratory diseases, treat this condition and take proper care of asthma affected young children and infants (Yeatts, 2015).

Learning outcomes

Through this workbook, the New Graduate Registered Nurses would learn

• Effects of undiagnosed asthma on paediatric patients.

• And develop skills to diagnose asthma in children.

• About treating everyday asthma in children.

• Skills to manage asthma emergencies in children.

Diagnosis of Asthma

 

A positive history of coughing wheezing, chest tightness and difficult breathing may suggest asthma. However, not all wheezes and coughs are related to asthma. In asthma, the symptoms worsen with smokes or other irritants, viral infection, weather change, exercise or active playing and sometimes allergens like pollen and animal fur. The symptoms also worsen at night (GINA, 2016).

Spirometry is common lung function test for identifying airflow issues, however, cannot be used for children below 6 years of age. So, in young children, a positive response to trial of inhaled bronchodilators and anti inflammatory medicines is suggestive of asthma. But no single finding can confirm the diagnosis. A child must have several findings along with classical symptoms to be called as suffering from asthma (Milligan, et al. 2016). Further, for identifying asthma pattern, following table may assist (National Asthma Council Australia, 2017).

Management of Asthma

Asthma is mainly controlled with the use of appropriate medications that can be relievers or preventers. Relievers: These medicines quickly relax the muscles around the airways and are usually used as asthma first aid drugs. Preventers gradually reduce the sensitivity of the airways to triggers (BTS, 2012). Every child has specific treatment needs depending upon his severity of symptoms, so a stepped approach has been suggested. This approach serves an effective guide to adjust asthma medication in children (National Asthma Council Australia, 2017).

Children must be given a spacer to take the medicine and the parents must be explained how to use this spacer (Koinis Mitchell et al. 2015). Spacers ensure that the medication effectively reaches where it is supposed to be. For infants and young children, Spacer comes with a special face mask that fit round their mouth and prevents drug leakage.

Asthma emergencies in paediatric patients

• On the basis of severity of acute asthma, whether it is moderate, severe or life threatening, bronchodialators are immediately started. • If needed, oxygen therapy is administered to target atleast 95% oxygen in children.

• Continuous observations and assessments are done when appropriate.

• Systemic corticosteroids are administered within the first hour (Weber, et al. 2017).

• Until acute asthma is resolved, the child’s response to treatment is repeatedly reassessed and as per the need, either the treatment is continued or added.

• The patient is observed atleast for an hour after the respiratory distress is resolved followed by delivering post-acute care and arranging follow-up (National Asthma Council Australia 2016).

References:

Australian Centre for Asthma Monitoring 2009. Asthma in Australian children: findings from Growing Up in Australia, the Longitudinal Study of Australian Children. Cat. no. ACM 17. Canberra: AIHW.

British Thoracic Society (BTS) 2012. Scottish Intercollegiate Guidelines Network (SIGN). British Guideline on the Management of Asthma. A national clinical guideline. BTS, SIGN, Edinburgh;

Cronin, J.J., McCoy, S., Kennedy, U., an Fhailí, S.N., Wakai, A., Hayden, J., Crispino, G., Barrett, M.J., Walsh, S. and O’sullivan, R., 2016. A randomized trial of single-dose oral dexamethasone versus multidose prednisolone for acute exacerbations of asthma in children who attend the emergency department. Annals of emergency medicine, 67(5), pp.593-601.

Ducharme, F.M., Zemek, R., Chauhan, B.F., Gravel, J., Chalut, D., Poonai, N., Guertin, M.C., Quach, C., Blondeau, L., Laberge, S. and research group of the Pediatric, D.O.O.R.W.A.Y., 2016. Factors associated with failure of emergency department management in children with acute moderate or severe asthma: a prospective, multicentre, cohort study. The Lancet Respiratory Medicine, 4(12), pp.990-998.

Global Initiative for Asthma (GINA). 2016 Global strategy for asthma management and prevention. GINA;. Available from: http://www.ginasthma.org/

Goeman, D.P., Abramson, M.J., McCarthy, E.A., Zubrinich, C.M. and Douglass, J.A., 2013. Asthma mortality in Australia in the 21st century: a case series analysis. BMJ open, 3(5), p.e002539.

Koinis Mitchell, D., Kopel, S.J., Williams, B., Cespedes, A. and Bruzzese, J.M., 2015. The association between asthma and sleep in urban adolescents with undiagnosed asthma. Journal of School Health, 85(8), pp.519-526.

Milligan, K.L., Matsui, E. and Sharma, H., 2016. Asthma in urban children: epidemiology, environmental risk factors, and the public health domain. Current allergy and asthma reports, 16(4), p.33.

National Asthma Council Australia (2017). Australian Asthma Handbook – Quick Reference Guide, Version 1.3. National Asthma Council Australia, Melbourne,. Available from: http://www.asthmahandbook.org.au

Weber, H.C., Bartel, D., Yusof, M.F., Frandsen, M. and Bassett, G., 2017. mproving adherence to paediatric asthma guidelines in a regional emergency department. In Australasian Asthma Conference.

Yeatts, K., 2015. “Health consequences associated with frequent wheezing in adolescents without asthma diagnosis.” K. Yeatts, K. Johnston Davis, D. Peden and C. Shy. Eur Respir J 2003; 22: 781–786. European Respiratory Journal, 46(5), pp.1532-1532.

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