Who is this document for?
This information is for parents or guardians whose child has attended the emergency department or been admitted to hospital after an asthma attack.
What is asthma?
Asthma is a chronic condition that affects the airways – the breathing tubes that carry air in and out of the lungs. Symptoms include cough, wheeze and breathlessness. These symptoms vary from child to child and may vary over time, so children may be well for several days or weeks before having an asthma attack. Children may get symptoms when they have a viral bug, exercise or during the night.
Asthma attacks are normally caused by a trigger which irritates the sensitive lining of the airways. Common triggers in childhood are viruses or colds, exposure to smoking, hay fever (pollen), pets or dust. Stress or childhood worries/ anxiety can also trigger asthma attacks.
What happens to my child’s body during an asthma attack?
During an asthma attack, also called an asthma exacerbation, the airways become swollen and inflamed. The muscles around the airways tighten and the airways produce extra mucus, causing the breathing (bronchial) tubes to narrow. During an attack, your child may cough, wheeze (a high pitched whistle or musical noise) and have trouble breathing.
What care will be given to my child during their time in hospital?
Your child will be seen by a children’s nurse and doctor who will look at the seriousness of their symptoms and check how they are.
Here are some of the common tests or treatment they might receive, or may have received:
- A test to measure your child’s heart rate and oxygen level using a finger probe.
- Listen to your child’s lung sounds with a stethoscope.
- Your child’s height and weight will be measured.
- Oxygen will be given if needed, via a face mask or nasal prongs.
- Nebulised (misty) medication via a face mask.
- Inhaled medication via a blue inhaler (asthma puffer) and spacer.
- A test to identify how well your child’s lungs are working – which might include a peak flow test if your child is five years old or older.
You will also be asked for details about your child and their history of asthma, medicines they take or what might have triggered this attack.
What medicine will be given?
These are medicines such as salbutamol which can be given with a blue inhaler and spacer or a nebuliser. They work by relaxing the tightened muscles around the breathing tubes and help the airways to open wider. This makes it easier to breathe.
A spacer is used to help deliver medicine into the lungs and it is the best way to give your child medicine from their inhaler (puffer). It has a mouthpiece or mask on one end and a hole for the inhaler at the other. Research shows using a spacer works as well as nebulisers in most asthma attacks. In this hospital we use Aerochamber spacers.
A nebuliser creates a mist of medicine that is then breathed in through a mask. Nebulisers are used if your child needs oxygen at the same time and can deliver higher doses of medication.
Your child will be given a short term (three day) course of steroids either in liquid or tablet form to help bring their asthma under control more quickly.
Preventer or maintenance inhaled steroids
Your child might be given a steroid inhaler (puffer) which is normally given twice a day, every day. This is a treatment inhaled into the lungs using a spacer. The steroid sits on the lining of the airways and helps to reduce how sensitive they are. This helps to prevent asthma attacks. These inhalers are normally brown, orange or purple.
When can I go home?
As your child begins to recover we can increase the time (interval) between when they are due more salbutamol (blue inhaler) normally from 1 to 4 hours. As soon as your child can cope with a four-hour space between their next dose of salbutamol (blue inhaler) without having symptoms, that is a good indicator that they are about ready to go home.
In addition, before you go home:
- Your child will be reviewed by a doctor including an assessment of what medicines your child is taking.
- A nurse will check your child’s inhaler technique.
- A nurse will give you an asthma action plan.
- Your child’s trigger will be identified.
- You will be seen by the children’s asthma nurse specialist or they may contact you by phone over the next few days.
- A nurse or doctor will also make sure you have the correct follow up arranged in a children’s outpatient’s clinic.
What shall I do when we get home?
After your child has had an asthma attack it is important that they rest as much as they need to. Children normally feel quite tired after an asthma attack and if you needed to stay in hospital this may have unsettled them.
Make an appointment for your child to be seen by their GP in two days’ time, so they can listen to your child’s lungs and make sure they are recovering well. Your GP may also need to replace your child’s blue inhaler for a new full one.
When can my child go back to nursery or school?
As soon as your child is back to their normal self they can go back to nursery or school. It is important to remember that your child will need regular salbutamol (blue inhaler) for the next few days. Check with the nursery or school that they are able to support you and your child with this.
How can I prevent this from happening again?
- Immediately after your child’s admission arrange a review with your GP in two days.
- Make sure your child completes the salbutamol (blue inhaler) weaning plan on your action plan.
- Make sure your child takes their asthma preventer/ maintenance steroid inhaler every day as prescribed.
- Not all asthma triggers are entirely avoidable, such as viruses, but where possible avoid your child’s trigger.
- Know your child’s asthma action plan and keep it accessible on your mobile phone or in their school bag as well as somewhere visible at home.
- Attend regular asthma reviews with your GP.
Contact your GP or the children’s asthma nurse specialist:
- If your child is needing salbutamol more than two times a week.
- If they have a night-time cough.
- If their asthma symptoms are stopping them doing the things they enjoy.
- If they have a further asthma attack, even if they feel better already.
What should I do if this happens again?
If your child begins to develop similar symptoms such as cough, wheeze or breathlessness refer to their asthma action plan.
What about smoking?
Children who are exposed to other peoples’ cigarette smoke are known as ‘passive smokers’. Passive smokers are more likely to have asthma, and are more likely to have recurrent asthma attacks increasing the risk of asthma related death. Passive smoking exposure reduces the effectiveness of inhaled asthma medications.
Research shows that even when household members smoke away from the child, as the by-products of smoking cling to breath and clothing, we can still find indicators of passive smoking in children’s urine.
The best thing you can do for your own health and the health of your child is to stop smoking. As this may be a very difficult thing for you to do, the best way to stop smoking for life is to seek help and support from your GP’s smoking cessation service.
Privacy & dignity
Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
Telephone +44 (0)1223 245151