1. General information
    1. Obstructive disease of the lower respiratory tract
    2. Most common chronic respiratory disease in children, in younger children affects twice as many boys as girls; incidence equal by adolescence
    3. Often caused by an allergic reaction to an environmental allergen, may be seasonal or year round
    4. Immunologic/allergic reaction results in histamine release, which produces three main airway responses
      1. Edema of mucous membranes
      2. Spasm of the smooth muscle of bronchi and bronchioles
      3. Accumulation of tenacious secretions
    5. Status asthmaticus occurs when there is little response to treatment and symptoms persist
  2. Medical management
    1. Drug therapy
      1. Bronchodilators to relieve bronchospasm
        1. Beta-adrenergic agents: rapid onset of action when administered by aerosol (see Figure 5.3 below)
        2. theophylline: check pulse and blood pressure
      2. Corticosteroids to relieve inflammation and edema
      3. Antibiotics: if secondary infection
      4. Cromolyn sodium: not used during acute attack; inhaled; inhibits histamine release in lungs and prevents attack
    2. Physical therapy
    3. Hyposensitization
    4. Exercise
  3. Assessment findings
    1. Family history of allergies
    2. Client history of eczema
    3. Respiratory distress: shortness of breath, expiratory wheeze, prolonged expiratory phase, air trapping (barrel chest if chronic), use of accessory muscles, irritability (from hypoxia), diaphoresis, change in sensorium if severe attack
    4. Diagnostic tests: ABGs indicate respiratory acidosis
  4. Nursing interventions
    1. Place client in high-Fowler's position.
    2. Administer oxygen as ordered.
    3. Administer medications as ordered.
    4. Provide humidification/hydration to loosen secretions.
    5. Provide chest percussion and postural drainage when bronchodilation improves.
    6. Monitor for respiratory distress.
    7. Provide client teaching and discharge planning concerning
      1. Modification of environment
        1. ensure room is well ventilated.
        2. stay indoors during grass cutting or when pollen count is high.
        3. use damp dusting.
        4. avoid rugs, draperies or curtains, stuffed animals.
        5. avoid natural fibers (wool and feathers).
      2. Importance of moderate exercise (swimming is excellent)
      3. Purpose of breathing exercises (to increase the end expiratory pressure of each respiration)

FIGURE 5.3 Instructions for use of an oral inhaler