What tools do you recommend for parent of an asthmatic child?

[SW-Shooter]

My 10 year old son has had Asthma for 5 years. He currently is on Xopenex and Advair.

He has skin allergies to grass, dust, etc....

I keep a battery and home powered nebulizer for him.

Is there anything else you could recommend for emergency treatment, care, etc...

Would a pulse oximeter be a good idea?

Thank you.

[Artos]

Only thing I would double and triple check is severe allergies to insect bites / stings. I have to carry an epi-pen every where I go and would think this could be even worse of asthmatics.

[chuckman]

Subcutaneous epi should be used in caution with children without proper guidance in knowing where a bad asthma attack ends and a dealy one begins. If you give epi willy nilly, you can really mess things up.

I would get a couple metered dose inhalers and a couple spacers. They can really help when you aren't around a nebulizer.

[SW-Shooter]

Subcutaneous epi should be used in caution with children without proper guidance in knowing where a bad asthma attack ends and a dealy one begins. If you give epi willy nilly, you can really mess things up.

I would get a couple metered dose inhalers and a couple spacers. They can really help when you aren't around a nebulizer.
I just ordered a spacer, thank you.

[Pathfinder Ops]

My 10 year old son has had Asthma for 5 years. He currently is on Xopenex and Advair.

He has skin allergies to grass, dust, etc....

I keep a battery and home powered nebulizer for him.

Is there anything else you could recommend for emergency treatment, care, etc...

Would a pulse oximeter be a good idea?

Thank you.

YES a pulse oximeter would be useful to you. Where they are "satting" is a very important indicator.

I would also never go anywhere without a spacer tube for the MDI of Albuterol if that's one of your "emergency meds." He may be a bit young for the MDI set up right now but if not make sure to use the spacing chamber.

The spacing chamber in short just slows the speed at which the med flies outta the MDI. MDI's are relatively hard to use effectively especially in children. Th spacer essentially captures the med as a mist in the chamber and the PT inhales it more efficiently. If you inhale to fast it sounds a tune that tells you slow down. It just makes things more efficient.

Also get a "Peak Flow Meter." this is also a good measure for where things are regarding his function.

These 3 things are a very important combination. The pulse x many would say well they are not mandatory and I would agree. But thye are very very useful and why the heck not right?

And Epi is only useful in "Status Asthmaticus." essentially this is a most severe circumstance ( WAY beyond a "bad asthma attack"). And frankly in all my years as a medic its only a few times a year that I see a need for that traetment modality. Typically if well managed asthma gets out of control your Doc or if you call an ambulance the Medic can get things slowed down with something called a DuoNeb enroute to the ER.

As previously stated be very careful with Epi in children unless an alergic cricumstance is the factor for the resp. distress.

Hope that's helpful.

[thopkins22]

Regular controlled breathing exercises like what people do in yoga or meditation. One type of the exercises is called Buteyko, but I don't know if that's the one that was effective, but it may give you some leads on other breathing exercises that may or may not be more effective.

I have no clue whether or not any medical professionals would recommend this(though I'm relatively sure they wouldn't advise against it,) but I know two kids with asthma who have gotten tangible benefits from it. Of course this shouldn't be viewed as a replacement for medicines nor any kind of medical treatment/advise you receive from your physician.

I'll ask the parents for the details on what the actual exercises entailed.

ETA:I realize you were asking about emergency treatments, and that my recommendations fall squarely in the preventative category but I felt it was pertinent.

[TehLlama]

Epi pen, and numerous albuterol inhalers helped me out, only had to be hospitalized twice myself.
The yoga style breathing exercises can go a very long way, I was doing that unknowingly, and that's what allowed me to play soccer as long as I did.

Peak flow meters can be useful for preventative, and the facial steaming things women use can actually be very helpful for allergy induced problems, as that can help discharge postnasal drip.

The exact blood oxygen isn't as important, it's usually not that hard to tell when a kid is in trouble, convincing them to stop long enough to administer care was the hard part in my case.

[9mm_shooter]

Your son is already on Advair and Xopenex, so he probably has at the very least a mild or moderately persistent form of asthma. You should have an asthma action plan set up with your doctor. It will have the list of actions that you would need to take when the peak flow meter shows changes. Usually we give a prescription for emergency oral steroids for the severest of episodes.

It looks like you already found out his triggers. This is good, but you should try to measure his lung function too, in case you haven't done it yet. This test is much more elaborate and informative than your peak flow meter. I think every child that has a need for a long acting beta agonist/steroid should get this done at least once (if not twice) a year by someone with specific pediatric asthma training. The equipment is different, and some kits can measure lung function in very young kids - even toddlers.

Learn about signs of respiratory distress in children. Pulse ox changes will be one of the last things you see before you are in big trouble. I would have him in front of a doctor long before then - particularly if he was in a "red zone" of his peak flow meter reading. Save your money, you'll need it for college his. Asthma is costly enough without having to spend money on stuff that will not add up to better care for your child.

PM me if I can be of further assistance. :)

[SW-Shooter]

Thanks for all of the info, keep it coming. Now off to find a decent pulse ox that won't break the bank.

[9mm_shooter]

This is the link to the page (http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm) with the latest expert panel report (http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf) for asthma. There is literally a metric ton of info here, but the specific part of the document that you should look at is this one. (http://www.nhlbi.nih.gov/guidelines/asthma/11_sec5_exacerb.pdf)

Please note that they use PEF and clinical findings to assess the severity of the exacerbation. Pulseox is notoriously not present in this document. Of course, the pulse-ox is helpful to assess the effectiveness of your therapy, particularly if you are already in a setting that has to decide if they need to get an arterial blood gas sample to see CO2 accumulation, but as a diagnostic measure to decide if you need to go to the ER, it is just not very useful. You should be able to tell if the kid is in need of medical O2 without it. Besides, in some cases, you may have a sick child that needs immediate medical attention that may still have a normal pulse-ox, and curiously enough, a child with a mild attack may actually have a transitory desaturation without being in respiratory distress. The reason is simple: if the kid is really hypoxemic, you have missed the boat big time. You see, the pulse-ox suffers from an additional problem: it may actually show a paradoxical desaturation in situations where there is VQ mismatch, which happens when the child has been treated with your albuterol or xopenex. This happens when parts of the lung get poorly aerated, and because of the low oxygen content in that area, the blood vessels to that part of the lung constrict, decreasing the blood flow to that area. When you use albuterol, it relaxes smooth musculature around the bronchi, but also around the blood vessels that are constricting blood flow to plugged parts of the respiratory tree. Those areas get renewed blood flow before they get expanded by air, and they absorb the CO2 that is trapped in those alveoli. The kid may not have any retractions, and have a mild asthma attack, and have a pulse-ox of 85%.

[MIKE G]

Consider one of these: http://www.allergybegone.com/devlexplaspo.html?zmam=15462522&zmas=1&zmac=6&zmap=dev45

Not endorsing the vendor, they just happened to be the first site with a pic.

This allows you to use the bullets of medication like you would in a normal nebulizer but requires no batteries or power like an MDI and can help with compliance over an MDI with a spacer. As well, it has the advantage of you knowing just how much medication you have left as opposed to an MDI being half empty or nearly gone.

Something to consider.

[SW-Shooter]

Consider one of these: http://www.allergybegone.com/devlexplaspo.html?zmam=15462522&zmas=1&zmac=6&zmap=dev45

Not endorsing the vendor, they just happened to be the first site with a pic.

This allows you to use the bullets of medication like you would in a normal nebulizer but requires no batteries or power like an MDI and can help with compliance over an MDI with a spacer. As well, it has the advantage of you knowing just how much medication you have left as opposed to an MDI being half empty or nearly gone.

Something to consider.

That is a great idea, "it's a what if there isn't any power for weeks" kind of product. Thank you very much, this is exactly the kind of information I needed. Wow!

Thank you for the link 9mm. Unfortunately, there is a metric ton of info out there, most of it is repetitive. But this was something I haven't seen before. It's very useful.

[chuckman]

Ah, yes, I shoulda mentioned peak flow meter. Definitely get one. I wouldn't bother with a pulse oximeter. As has been said, they are often unreliable, the last thing to show the seriousness of a hypoxic event (by the time the SpO2 drops, you are already in deep doo), and many other things can give unreliable numbers. You know your son, his signs and symptoms, his medications, his triggers. You are a solid clinician at this point, so continue relying on clinical indicators as to the seriousness of any attack.

[SpookyPistolero]

The pulse ox isn't really a home-use sort of item, it's not something you'll need or be able to make use of.

Everything has been mentioned. Get Benadryl liquid (and injection if you can get a script for it), Epi Pen jr., and a couple of spare albuterol inhalers in separate locations (go-bags, etc). I haven't found research that convincing regarding the success of the peak flow meter.

[SW-Shooter]

I will still buy a pulse ox, to have as just another tool.

[Cardiac Nurse]

Sounds like y'all have it covered. I carry an Albuterol inhaler in my purse at all times, in my kids' backpack or carry bag and one in my med bag. The spacer stays with the one in the med bag. In an emergency you can poke a hole in the bottom of a disposable cup and put the inhaler mouth piece through the hole and place the cup over the child's nose and mouth and have them inhale the med. We carry an inverter in our vehicle when we are on the road so we can plug in the nebulizer and give a treatment if needed. I keep liquid steroids, inhaled steroids on hand in my med bag as well. Our pediatrician and I set up a plan of care so that I can treat as needed within those guidelines and seek assistance when needed. We have traveled during flare ups and have had flare ups while we are traveling but have been able to control the symptoms. For us the biggest thing has been controlling the allergies which cause the asthma to flare. We use daily meds when allergy triggers are present and are able to take med breaks (with pediatrician approval).

[airwayguru]

Working with astmatics and being one myself I would recommend fresh batteries after each use of the battery operated nebulizer. After one use you are loosing the force needed to give the albuterol. I had a patient who did not have fresh batteries in her battery operated nebulizer and I end up sending her to the ER.

What everybody has been said and what you have is good so far.

Prevention is the primary key.

[SW-Shooter]

Working with astmatics and being one myself I would recommend fresh batteries after each use of the battery operated nebulizer. After one use you are loosing the force needed to give the albuterol. I had a patient who did not have fresh batteries in her battery operated nebulizer and I end up sending her to the ER.

What everybody has been said and what you have is good so far.

Prevention is the primary key.

I bought the Pari Trek S, with power pack, so the batteries are rechargeable. I should find out where to find replacement ones.

http://www.pari.com/pdd/trek-s.htm

[browningboy84]

Only thing I would double and triple check is severe allergies to insect bites / stings. I have to carry an epi-pen every where I go and would think this could be even worse of asthmatics.

Artos,

I am not an asthmatic, but I am like you. I need an Epi-Pen on me due to my bee/wasp/hornet allergies. Last time I got stung I was in Paramedic School on my day off, and had to call my co-workers to me. I got hit with SQ epi that day, but being the stubborn person I am, refused to carry an Epi-Pen till my wife made me. :cool: She is also a Paramedic, and so she finally cut me.... err, reasoned with me till I agreed to carry it on me, or at least in my vehicle at all times. :D