hi i am a very worried aunt my 6yrs old nephew is going in and out of the clinic because of asthma .please help me manage this disease

[strawchoc]

he had an attack on sartuday and i took him for nebulising after i had given him his inhaler which worked for few hours,and after they nebulised him i could still hear a bit of wheezing when i told the nurse she said hz gonna b fine it wont stop immedietely n they gave him antibiotics .but at night it started again i gave him his blue inhaler and he still having shortness of breath but its not severe .so i would like to ask if its safe to give him blue inhaler more than once ?do i still use the brown one which he uses twice a day or when he have attack i only focus on the blue one?help me i just get worried and panic a lot

[Troilus]

Hi strawchoc.

I am so sorry your nephew is struggling. You must be frantic, but you have come to the right place for advice.

I have no experience with childhood asthma, but I will try to be a little bit of help, in the hope that someone who does have experience comes along.

Firstly, his brown inhaler should be taken every day. This is his preventer inhaler. It should be taken even when your nephew is well.

Next. Yes, he can take more than one puff of his blue inhaler. Leave about a minute (sometimes mine is a short minute) and give a second dose.

An adult can take up to 9 doses in an emergency, not sure about a child. I’ll see if I can find out for you.

Next. I think it would be a good idea to ring your nephew’s GP and let him know the situation. Maybe there is something else they can give your nephew. I know Montelukast comes in a children’s version, but whether or not this would be suitable for your nephew I don’t know.

Does he have a spacer? I know some children are given very large clear plastic ones with a mouth piece.

You can also buy children’s spacers with a mask attached. I have an adult one which I find very good if I am breathless or having an attack.

Whichever type he uses, try tidal breathing. This is where you just breath in a normal way but a little more deeply if you can. They tend to say 5 breaths a dose, I sometimes do more. When one dose has been administered shake the canister and repeat. Personally I find this method much more reassuring than trying to suck and hold - you just don’t have the breath in an attack and can end up temporarily more out of breath than when you started.

I must say, I am shocked and appalled that he was discharged while still wheezing but doesn’t mean you can’t take him back if you are unable to regain control of his breathing using the blue inhaler.

I was told that 9 salbutomol taken through a spacer is the same as a nebuliser.

If your nephew does not improve or keeps having attacks or breathlessness please seek medical help for him.

[Troilus in reply to Troilus]

This is from the NICE guidance. Link attached

Moderate and severe acute asthma

By inhalation of aerosol

For Child

2–10 puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or when required, give via large volume spacer (and a close-fitting face mask in children under 3 years), each puff is equivalent to 100 micrograms.

bnfc.nice.org.uk/drug/salbu...

If he has not improves after the maximum dose, ring for an ambulance.

As for his current situation the fact that they have given your nephew antibiotics suggests that they think he has got a chest infection.

In this case he will likely have phlegm in his airways. Giving him a regular dose of salbutomol every 4 hour should help to keep his airways open and make it a bit easier for him to cough up.

It is not a good idea to use vick or or other rub on or inhaled decongestants like albas oil as they can trigger a reaction in some people with asthma.

Push fluids and some will say avoid dairy products while he has the infection.

Asthma attacks can be very frightening, not just for the person having them, but for those, like yourself who are trying to help.

When you nephew is having an attack, stay calm, administer the salbutomol, and ooze lots of reassurance.

I hope things have settled for him.

[strawchoc in reply to Troilus]

Hi Troilus

Thank you very much for your reply it really helps to shared some light on how I should handle this I really appreciate it.my nephew does have a spacer that was given to him at the hospital .and thank God the wheezing has stopped he is fine now although I was really scared n heartbroken seeing him like that but m sure with the help of this family I'll get better in managing him. thanks alot❤️

[Troilus in reply to strawchoc]

Oh you will strawshoc. It is so very frightening to see someone in distress, especially someone so young. If it does happen again, start giving him the blue inhaler at the first symptoms. It really is magic!

[Poobah]

One of the things that really helped me when I was a kid, during an asthma attack someone would rub or gently paddle my back with their hands. This helps the patient breath out at a time when they are gasping for air.

Obviously, if your nephew indicates that he doesn't want this help then stop, it's important that he doesn't get any more agitated than he already is.

Ensure he has enough pillows (artificial filling in case he's allergic to feathers) so he can be propped up while sleeping - this helps breathing. While he's poorly, maybe double his blue inhaler before bed time to help him through the night.

Definitely talk to his GP about extra medication while he's poorly, and make sure he has enough Blue and brown inhalers at all times. Hopefully, the GP will recommend that your nephew see the asthma nurse regularly. They can monitor your nephew's asthma over time and find ways to help him control his asthma and they should develop a written plan for him (& you) - this will explain what to do when he starts to struggle with his breathing and what to do when that doesn't work.

I do hope your nephew makes a full recovery very soon.