This is a clinical diagnosis defined as increasingly severe asthma not responsive to usual drugs. Child is too breathless to feed or talk; there is severe chest retraction; tachypnoea.
- May have features of respiratory failure:
- Altered consciousness
- Poor respiratory effort
- Silent chest
- Admit: Child may need ICU care
- Monitor vital signs every 15–30 minutes.
- Keep propped up in bed.
- Administer oxygen by intranasal catheter flow rate of 1–2 litres per minute.
- Treat as per acute attack of asthma (see section on asthma above).
- Look for and correct dehydration.
- Avoid antibiotics unless specifically indicated.
- Ventilate if necessary using bag and mask
LONG-TERM AND HOME CARE OF ASTHMA
This depends on severity
- Mild intermittent: Daytime symptoms <2 per week and night <2 per month.
- Care: short/rapid acting bronchodilators as needed.
- Mild persistent: Daytime symptoms >2 per week and <1 per day; night >2 per month.
- Care: Long-term medication – low dose inhaled corticosteroids daily.
- Attacks – Short/rapid acting bronchodilators
- Moderate persistent: Daily symptoms and night >1 per week
- Care: Long-term medication – low to medium dose inhaled corticosteroids daily with or without long acting bronchodilator.
- Attacks – Short/rapid acting bronchodilators.
- Severe persistent: symptoms continuous during day and frequent at night.
- Care: Long-term medication – daily high dose inhaled corticosteroids and long acting bronchodilators with systemic steroids if needed.
- Attack: Short acting bronchodilators.
Important to note:
- Clear and preferably written instructions on how and when to use the inhaler at home.
- Report immediately to a health facility when home treatment is ineffective.
- Avoidance or reduction of triggers/allergens in the home.
- Child in school with exercise induced attacks should use the inhaler before exercise.