Asthma Attack

Don’t use this guideline unless your child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician

Main Symptoms

• The classic symptom is a wheeze or whistling (purring) sound on breathing out.

See More Appropriate Topic

• If no previous asthma diagnosis or use of asthma medicines, see Wheezing

Call 911 Now (your child may need an ambulance) if

• Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)
• Your child passed out or has bluish lips/tongue
• Wheezing started suddenly after medicine, an allergic food or bee sting

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Looks like he did when hospitalized before with asthma
• Difficulty breathing not resolved 20 minutes after neb or inhaler
• Peak flow rate < 50% of baseline level (personal best)
• Peak flow rate <50-80% of baseline level after using neb or inhaler
• Wheezing (heard across the room) not resolved 20 minutes after using neb or inhaler
• Continuous (nonstop) coughing that keeps from playing or sleeping and not improved after using neb or inhaler
• Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours
• Fever > 104°F (40°C)
• Severe chest pain

Call Your Doctor Within 24 Hours (between 9 and 4) If

• You think your child needs to be seen
• Lots of yellow or green nasal discharge now with a fever
• Sinus pressure or pain
• Fever present > 3 days

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Missing > 1 day of school/month for asthma
• Asthma limits exercise or sports
• Asthma attacks frequently awaken from sleep
• Uses more than 1 inhaler/month
• Mild wheezing persists > 5 days
• No asthma check-up in > 1 year

Parent Care at Home If

• Mild asthma attack and you don’t think your child needs to be seen

Home Care Advice for Asthma Attack

1. Asthma Medicine:
   • Start the inhaler, nebs or oral asthma medicine at the first sign of any coughing or shortness of breath (don’t wait for wheezing).
   • The best “cough medicine” for a child with asthma is always the asthma medicine. Continue the asthma medicine until your child has not wheezed or coughed for 48 hours.
   • It takes a minimum of 7 days of medicine for lung function to return to normal.
2. Hay Fever: For nose allergy symptoms, it’s OK to give antihistamines.
3. Fluids: Encourage a normal intake of clear fluids (e.g. water). (Reason: normal fluid intake keeps the lung mucus from becoming sticky.)
4. Humidifier: Humidifier: If the air is dry, use a humidifier (Reason: to prevent drying of the upper airway.)
5. Avoid or Remove Allergens: Give a shower to remove pollens, animal dander, or other allergens from the body and hair. Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows, exercise).
6. Expected Course: If treatment is started early, most asthma attacks are quickly brought under control. All wheezing should be gone by 5 days.
7. Call Your Doctor If
   • Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours
   • Wheezing is not completely cleared by 5 days
   • Your child becomes worse or develops any of the “Call Your Doctor Now” symptoms