Your child is about to be discharged from hospital following admission for wheeze or asthma. It is important to us that your child is safe and you know how to manage at home in the next few days, and if this happens again.
Please watch this presentation carefully. Your bedside nurse will get you to sign your education checklist before you are discharged. Ask your bedside nurse or treating doctors if you have any questions.
Wheeze is a sound that comes from the small airways in the lungs. It can happen with inflammation of the airways, with or without tightening of the muscles surrounding these airways.
Children may have one or many wheezing illnesses in their lifetime. It is common for children to develop a wheezing illness in the first few years of their life. However, not all children will develop asthma.
In children who are under five years, the majority of wheezing episodes happen due to a viral infection, which inflames the airways. This can have many names including preschool, wheeze, viral wheeze, or reactive airways disease. Two thirds of these patients grow out of this. Stop wheezing as they get older and will not go on to have asthma.
Children over five years of age may be diagnosed with asthma if they have recurrent episodes of wheeze. This is more likely in children who have had family members with asthma or allergic symptoms such as food allergies or eczema.
Can you explain your child's wheezing illness?
Normally your child's airways are open and clear. When your child is unwell, their airways may become tight and inflamed. They swell and become full of thick mucus. These changes in your child's small airways make them narrower, and it is harder to breathe. It is almost like breathing through a straw.
What are the symptoms of a wheezing illness?
Children present with a wide variety of symptoms. Some common symptoms can include your child may tell you that it is hard to breathe or that it feels tight in their chest. Sometimes they might not be able to say a full sentence because they feel out of breath. They may also be more tired.
Breathing
You may be able to hear your child's wheezing, especially when they breathe out.
Cough
A persistent cough may be a sign of a wheezing illness, especially one that occurs at night or early in the morning when the weather is cooler and during exercise. Younger children may tell you that they have a sore tummy or there is something sitting on their chest. You may notice that your child's stomach is moving in and out more than usual.
If these symptoms are new for your child, or you are unsure about what the cough or wheeze could be, please see a doctor who can listen to your child's chest. When a child's asthma condition is severe, your child may be very distressed, exhausted, or even limp. You may see that your child's stomach, ribs, and throat is sucking in and out if they are struggling to breathe.
Asthma can be life-threatening and if you are worried about your child, call an ambulance on triple zero.
Do you know what can trigger a wheezing illness?
A trigger is something that brings on the wheezing illness. Triggers include viral infections, dust pollen, mold, smoke, and animal fare. Tobacco smoke is a major trigger in children
Reliever medication
Reliever puffers are used to relax the narrowed muscles in the breathing tubes. Relievers are very quick acting and should only be used when the child has symptoms. They contain the medication salbutamol. There are different brands of reliever puffers, but they are usually blue in colour. The most commonly used in Australia are Ventolin or Asmol. These can be purchased over the counter at the pharmacy if you run out at home and cannot see a doctor.
Preventer medication
Preventers can be prescribed for children who suffer from recurrent episodes of wheeze. Preventers work By decreasing the inflammation in the airways and drying up the mucus. Preventers must be taken every day even if your child is well. Different coloured puffers contain different medications. Your doctor will prescribe the one best for your child.
The possible side effects of preventers can include oral thrush, voice change, and sore throat. To prevent these, ensure that your child rinses goggles and spits after you give the preventer puffer. For smaller children, you can brush their teeth instead.
Checking if the puffer is full and knowing the expiry date
It is important to check if your puffer is full and it is not expired. Give the puffer a shake, you should be able to feel the medicine moving around. The expiry date can be found by removing the metal canister from the plastic case and looking at the label.
Oral steroid medication
On discharge, your child may be prescribed an oral steroid medication, usually prednisolone and commonly known as redipred. Remember that some young children will not need steroids to treat their illness. Please follow the instructions on the script from your doctor.
Using the puffer and spacer
A puffer should always be administered using a spacer. Younger children should also use a mask on the end of the spacer. Remove the cap, shake the puffer, and then place it in the end of the spacer. Ensure the mask is well fitted to the face of the child. Going around the nose and mouth. Press the puffer and wait for the child to take four to six breaths.
You should be able to hear the click of the valve in the spacer if your child is taking a deep enough breath.
Shake the puffer in between each dose and continue For the number of puffs as outlined in your action plan.
Care and cleaning of the spacer
To clean the spacer and mask, wash them in warm soapy water and leave them to air dry. Do not dry spacer with a cloth or paper towel as this can affect the dose of the medication administered next time you use it. You should clean the spacer and mask at least every two weeks before you use a clean spacer prime the chamber with two puffs and shake. This step is important to ensure that your child is getting the full dose of medication.
Using the written Wheeze or Asthma Action Plan
The wheeze action plan outlines the steps to follow after you discharge from the hospital. It is important to follow this advice to ensure your child's wheezing illness continues to improve.
The reliever medication needs to be given every three hours on the first day, even overnight. If your child is improving, then give the reliever every six hours on the second day. If there is continued improvement, then give your child the reliever every eight hours on the third day. Then you can return to the normal action plan.
The traffic light coloured faces on your action plan is helpful in recognizing when your child's wheezing illness is worsening.
When your child is well, there is no need to use the reliever puffer. However, your child should always carry their puffer, spacer and mask if you use one.
When your child is unwell with a cough or a wheeze, use your reliever when required up to every three hours.
If the symptoms do not get better or if they get worse, then you need to see a doctor. It is important to seek help if your child is needing the reliever more than every three hours, or waking up from sleep with a wheeze. If your child needs it every three hours for more than 24 hours, then you should also see a doctor.
If your child is unable to speak, has blue lips or is really struggling to breathe, then you need to call triple zero for an ambulance. Administer the reliever puffer every five minutes until the ambulance arrives.
A wheezing illness can be well controlled when following the advice and care plan following discharge from hospital together with your GP.
For more information, go to the Children's Health Queensland website or Asthma Australia. Thank you to the staff and children from Queensland Children's Hospital Emergency Department.
One in nine Australian children has asthma. It's one of the most common reasons children visit their doctor or go to hospital. It is important to know that children are not simply small adults. Information that applies to adults does not always apply to children. This section gives you some important information, especially related to children with asthma. It is important though, to talk to your doctor if you are unsure of anything about your child's asthma.
How do we tell if our child has asthma ?
Children with asthma can have many different symptoms. They may have trouble breathing. They may wheeze or have a persistent dry cough. Your child may feel breathless. They may have trouble describing this sensation and may even describe discomfort in their chest or tummy.
There is no test that proves a child has asthma. However, children with asthma will have repeated bouts of wheeze and difficulty breathing. Your doctor will ask you questions about your child's breathing to make sure they do not have any other condition, which could also make them wheeze. They may even try asthma medication to see if the child's symptoms get better.
Children who are six years and older may be able to do breathing tests called lung function testing.
What is wheeze?
Wheeze is a high pitched musical sound typically heard when a child breathes out. It is caused by narrowing of the small air pipes of the lungs. Because children are smaller than adults, their air pipes are smaller and they are more likely to wheeze.
Children may make a purring rattle sound when they breathe. This is not a wheeze. Make sure you tell your doctor about any sounds your child makes when breathing.
Cough
Children with asthma often have a dry cough. Cough is a common symptom in children. Children who cough and who do not wheeze are unlikely to have asthma. Your doctor can talk to you further about this.
Pre-school wheeze
It is common for young children to wheeze when they have a virus or cold. Many children who wheeze when they're young, stop wheezing by the time they start school. Some children who wheeze only when they have a cold, may not have asthma. Some asthma medications that are used in adults may not work in young children with wheeze.
You and your doctor may decide to trial medication. It is important you understand what medication your child is taking and how it is to be taken. If the medication does not appear to be working, talk with your doctor.
Asthma attack
How do you tell if your child is having an asthma attack? They may appear to breathe faster or harder than normal. You may notice the skin above your child's collarbone or over their lower ribs sucking in. You might also notice their stomach sticking out more than usual as they breathe in deeply. They may also say their chest feels tight or sore.
You may hear wheezing. This is a high-pitched musical sound when they breathe out. It can sometimes only be heard by the doctor. They may also have a persistent, irritating cough that is usually dry. You may notice this first at night or early morning, and it's often present after they have been playing sport or running around.
You may just think that something doesn't seem right with their breathing. Every child will show different signs, so it is important you know your child well and don't be afraid to see your doctor if you think you need to.
Narrator: Do you have an asthma action plan? An asthma action plan helps you to recognize when you or your child's asthma is getting worse and reminds you what to do when this happens. It also provides you with important information on when and how to get medical help quickly.
Asthma Australia recommends that everyone with asthma has an asthma plan from their doctor. This should include your personal medication plan and what to do if your asthma gets worse. A copy of the plan should be given to carers, for example, childcare workers, school and preschool staff, and relevant family members. If you do not have an action plan, see your doctor as soon as you can to have this completed.
If your symptoms are in the green zone, it indicates that your asthma is reasonably well controlled and you should carry on taking your medications as the doctor has prescribed. If you are in this green zone, you will notice that you are using your blue puffer less than three times a week, and that doesn't include using it before you exercise.
If you notice that you are using your blue puffer more than three times a week, And you have started waking up wheezing or coughing during the night more than a couple of times a week, your asthma may be getting worse. If you look at the action plan your GP has given you, you will now be in the yellow section. Your doctor may give you extra medications to take to get this under control. Follow your plan and see your doctor if your symptoms don't improve. If you are using your blue puffer every three to four hours, and waking up every night or morning feeling very wheezy and your chest is tight, then your asthma may be severe.
Look at your plan and follow the directions your doctor has written for you in the orange section. This may include starting some oral steroid tablets, or it may ask you to see your doctor straight away.
If you are experiencing severe shortness of breath, you are having difficulty speaking in sentences because of your breathing and you don't seem to be getting much relief from your blue puffer, you should follow the asthma first aid on the action plan and call 000 immediately. Please watch the section on asthma first aid. It is extremely important to know what asthma first aid is, and highly recommended that you watch the Asthma first aid section and then read your action plan.
An asthma attack can be frightening for both you and your child.
It is important to remain calm and sit your child upright. Give reliever medication. All reliever medications are blue. Shake the blue puffer and take the cap off. Use your child's spacer. How to use a spacer is explained in another section. Puff one puff of medication into the spacer.
Mum: Slow breaths.
Ready? 1, 2, 3, 4.
Narrator: Watch your child take four effective breaths. Repeat this step four times until your child has taken a total of four puffs of medication. Wait for four minutes. At the end of four minutes, look at your child's breathing. Do they look and feel better? Is there any improvement or are they still breathing faster or harder than normal?
If they are not better, give another four puffs of reliever medication as before.
Mum: Good. Four breaths slowly. 1, 2, 3, 4.
Good boy.
Narrator: If your child is not improving, you should seek further help. It is difficult to give general advice, however, acute asthma that is not responding to reliever medication is a medical emergency.
Dial triple 0 and talk with the operator.
Mum: Hello, ambulance? Yes. My two year old son's having an asthma attack.
Narrator: Continue to give four puffs of reliever medication every four minutes until emergency assistance has arrived.
Mum: Come on, four breaths slowly. Ready One.
Narrator: It is important that your child has an asthma management plan. This plan should be specifically for your child and written by your doctor. It tells us how to manage your child when they are well and what to do when they become unwell. It takes into account the severity of your child's asthma.
Keep this plan up to date and make sure it is in a place you can find it easily. Maybe on the fridge. Share this plan with others who may need to manage your child when they are unwell.
What do I do if my child is having an asthma attack?
If you have an asthma management plan, then you should follow that. If you don't have a plan or if you are unsure what to do, then follow the asthma first aid plan. This is the same for adults and children. However, very young children may need to use a face mask with their spacer.
Asthma first aid steps
Narrator: An asthma attack can be frightening for both you and your child.
Step one, it is important to remain calm and sit your child upright.
Step two, give reliever medication. Use your child's spacer. How to use a spacer is explained in another section. All reliever medications are blue. Shake the blue puffer and take the cap off. Puff one puff of medication into the spacer. Watch your child breath. Take four effective breaths. Repeat this step four times until your child has taken a total of four puffs of medication.
Step three, wait for four minutes. At the end of four minutes, look at your child's breathing. Do they look and feel better?
Is there any improvement or are they still breathing faster or harder than normal? If they are not better, give another four puffs of reliever medication as before.
Mum: Four breaths slowly. 1, 2, 3, 4.
Narrator: Step four, if your child is not improving, you should seek further help. It is difficult to give general advice, however, acute asthma that is not responding to reliever medication is a medical emergency.
Oh my God. Dial triple O and talk with the operator.
Mum: Hello, ambulance. Yes. My two year old son's having an asthma attack.
Narrator: Continue to give four puffs of reliever medication every four minutes until emergency assistance has arrived.
Mum: One full breath, slowly. Ready?
Summary
Mum: Step one. Remain calm. Sit the child upright and locate your child's asthma management plan.
Step two. Give reliever medication. Give four puffs via a spacer. Watch your child take four effective breaths after each puff of reliever medication.
Step three. Wait for four minutes and check to see if your child has responded. If no improvement, give another four puffs.
Step four. If your child is not improving, call an ambulance while waiting for help continue to give four puffs of reliever medication every four minutes.
Children with asthma have recurrent bouts of wheeze and difficulty breathing. Wheeze is a high pitched musical sound typically heard when a child breathes out. If your child is having an asthma attack, follow their asthma management plan or the asthma first aid plan.
Managing asthma is different in children and adults. Some medications do not work well in young children. The goal is for you and your child to lead an active and healthy life.
Andy is going to play football and he knows that this activity makes him wheezy and cough a lot. Note that Andy checks that his inhaler is not empty prior to use and that it is in date.
(First puff- four breaths)
Mum: Taking your blue reliever puffer five to 10 minutes before exercise can help reduce the symptoms of asthma and enable him to complete a game without symptoms or needing to stop.
(Wait 30 seconds)
(Second puff - four breaths)
Mum: When giving puffers to small children, it is best to use a puffer and spacer with a mask. This helps to ensure that the child receives adequate amounts of the medication.
Mum: Come on, you're doing good. Breath slowly one.
Narrator: Using this method is as effective as using a nebuliser. Nebulizers require an electricity supply and are very noisy and time consuming to use.
Mum: Slow breaths. Ready One.
Narrator: Nebulisers also require regular servicing to maintain their effectiveness. When taking regular preventer puffers, you should always rinse your mouth out to reduce the risk of developing thrush in the mouth.
Spaces are very easy to clean and maintain. Once a month, take the spacer apart and wash it in warm soapy water with no rinsing. With the soap bubbles on, leave the spacer to drip dry on the draining board. Spacers should not be dried caring for your spacer. This way lessens the static inside the spacer, stops the medicine from sticking to the sides and helps medicine get into your lungs better.
Prednisone and similar medication reduces swelling and mucus produced by the airway very quickly. It is taken when asthma is severe and not responding to inhaled preventer medication.
Inhaled steroid preventers like flixotide, pulmicort, qvar and alvesco reduce the swelling and mucus produced by the airways and make the airways less sensitive. Side effects can include thrush of the mouth, voice change, sore mouth, or throat. This can be minimized by using a puffer and spacer, rinsing, gargling, and spitting after taking the medication.
Exercise and activity is vital for keeping you fit and healthy. Asthma during or after activity may be a sign of poorly controlled or exercise induced asthma (EIA). If you cough, feel tight in the chest, feel short of breath, or wheeze with physical exertion, and these symptoms do not improve within a few minutes, take your reliever and see your doctor for advice.
You may have exercise induced asthma. At rest you breathe through your nose as air moves through your nose. It is warmed and moistened. When you exercise you breathe faster through your mouth, inhaling, cooler, drier air. This may act as a trigger for your asthma.
To prepare for exercise or activity use your blue reliever medication five to 10 minutes before you warm up. Some preventer medications and long-acting reliever medication may also help to prevent exercise induced asthma. Always warm up before exercise by doing 15 to 20 minutes of light, intermittent exercise or stretching, or five to seven 30 seconds sprints every two to three minutes, about 30 minutes before exercise.
Always carry your blue reliever in case you need it. Always cool down following exercise and activity when you get exercise-induced asthma, stop exercising all your activity. Take one puff of your blue reliever into your spacer and take four breaths. Repeat for another three puffs. If your symptoms persist or return when you recommence activity, use your blue inhaler as before. Do not return to activity or exercise for the rest of the day and see your doctor for advice on your asthma management.
If your symptoms persist, follow the asthma first aid plan and seek medical attention.
People with asthma who smoke experience worse,
- asthma control,
- more airway swelling,
- a poorer response to preventer medication, and
- accelerated decline in lung function.
People with asthma are just as likely to smoke as people without asthma Overall. 26% of people with current asthma smoke with higher rates among younger people with asthma than older people with asthma.
An estimated 11% of Australian children with asthma live in homes where smoking occurs inside the home.
If you need assistance to quit, contact your health professional.