Asthma and wheeze education for families

Transcript

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.