do you continue nebulizer use for rhonchi lung sounds

Laboratory studies are generally not indicated in a routine acute exacerbation. Yrs) or those who are very sick, arterial blood gas analysis or pulse oximetry should be used to assess the response to therapy and take a decision to transfer the child to intensive care unit.Ĭhest Radiograph and Other Laboratory Studies The two methods of objective measurement of lung function that can be used are: (i) measurement of air flow obstruction by peak expiratory flow rate (PEFR) or forced expiratory volume in the first second (FEV 1) and (ii) arterialīlood gas analysis (ABG) or pulse oximetry. An objective measurement of lung function thus becomes necessary. More importantly, even when symptoms and physical signs are minimal, the patient may have considerable degree of airflow obstruction. Many patients may not perceive any distress even when they have moderate degree Examination should be repeated after each step of treatment to assess the response. In any child with severe degree of respiratory distress, presence of alteration of sensorium, confusion, and cyanosis will suggest respiratory failure. Categorization of an acute exacerbation of asthma into mild, moderate or severe can be done based on physical examination and objective parameters as shown in Table I.

The initial examination Should rapidly determine the severity of airflow obstruction,ĭegree of hypoxia, and identify complications. These factors, if present, increase the risk of the attack becoming very severe and such children should be intensively monitored. It is necessary to know the duration of worsening and any specific allergen or irritant which could have triggered the attack, any history of previous hospitalizations, frequent emergency visits, chronic corticosteroid use or recent withdrawal from systemic steroids and history of previous admissions to intensive care unit or intubation. Once an appropriate level of management has been instituted in a sick child, a detailed history should be taken with emphasis on certain points. In case the child does not have a very severe attack of asthma, a detailed assessment is done based on history, physical examination and objective measurement of the degree of airway obstruction and hypoxia. Enquiries should be made about availability of a bed and child transferred as quickly as possible after initiation of oxygen and inhalational therapy with the help of nebulizer or MDl and spacer, the same being continued on the way. The features of a life threatening attack are: (i) Cyanosis, silent chest or feeble respiratory effort (ii) Fatigue or exhaustion and (iii)Īgitation or reduced level of consciousness.Īny child with features suggestive of a life threatening attack should ideally be treated in a hospital where intensive care facilities are available. One can immediately identify severe or life threatening cases and give these patients vigorous therapy even before going for detailed Initial assessment is necessary to rapidly determine the degree of airway obstruction and hypoxia. Planning the treatment protocol for a childĪssessment of response to therapy and modification of therapy. asthma that does not respond to conventional therapy is called status asthmatics. This article incorporates the guidelines given by International consensus groups and also suggests alternative therapies.Īcute exacerbations of asthma are acute episodes of progressively worsening short- ness of breath, cough, wheezing, chest tightness or a combination of these symptoms. For proper management of acute asthma, it is essential to follow set guidelines. There has been an increase in mortality as well, particularly in younger age groups(5-8). There is enough data globally to prove that the prevalence and severity of asthma is increasing(1-4). Sethi, Professor, Department of Pediatrics, Maulana AzadĪcute exacerbations of asthma are an important cause of morbidity, school absenteeism and frequent visits to the clinic or hospital. The Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital,

Do you continue nebulizer use for rhonchi lung sounds