Emergency Asthma Treatment — Before, During and After a Trip to the
Emergency Room
Bradley E. Chipps, MD has expertise in pediatric pulmonology and allergy and
clinical immunology. He is also the Medical Director of Respiratory Therapy and
the Cystic Fibrosis Center at Sutter Medical Center in Sacramento, CA.
AsthmaKidCare™: How do I know if my
child needs emergency asthma treatment?
Dr. Chipps: Sometimes it’s hard to know if
you need to take your child to the emergency room. But there are certain signs
you can watch out for that will help you make the decision. If your child’s
breathing is labored and he or she does not respond to their short-acting
bronchodilator within 20 minutes, go to the ER. Significant wheezing and
coughing are other conditions that call for a trip to the ER. You also need to
pay close attention to your child’s overall appearance and behavior. If the
child is very pale and unusually lethargic, he or she needs to be seen by a
doctor. In general, if your child is not responding to the things you normally
do when they experience asthma symptoms, go to the ER.
AsthmaKidCare: How can I be prepared in case
I need to take my child to the ER?
Dr. Chipps: While the goal of any asthma
treatment plan is to prevent symptoms and attacks, it’s a good idea to be
prepared in case of an asthma emergency. The doctors at the ER will need to get
a complete history of your child’s condition and treatment plan, including
current medications and recent peak flow readings. Basically, they need to know
what has and has not worked for your child in terms of asthma treatment so they
can choose an alternative. Be prepared to describe which medications your child
has taken in the past and which ones they are taking now. The doctors will want
to know the dosages of the medications and how they are administered (oral or
inhaled). You might want to take the medications themselves with you to the
emergency room. Also, if you have not been following the treatment plan
outlined by your doctor, you need to let the ER team know that.
AsthmaKidCare: How can I make a trip to the
emergency room less stressful for my child?
Dr. Chipps: Going to the emergency room can
be stressful even for an adult. So it is very important that you stay with your
child the entire time. To the best of your ability, try to explain what is
going to happen while you are at the emergency room. Help your child understand
that the people in the emergency room are there to help, not hurt him or her in
any way. Finally, remember that if you are stressed and anxious, your child
will pick up on that. Try to remain calm on the outside, even if you’re
panicking on the inside.
AsthmaKidCare: What can I expect once we get
to the ER?
Dr. Chipps: The team at the emergency room
will do tests to determine how severe your child’s asthma symptoms are. Most
likely they will take a peak flow reading and do a blood test to measure the
amount of oxygen in the bloodstream. If necessary, your child may be given
oxygen until his or her condition is stabilized. If there is an infection, your
child will probably be given an antibiotic.
AsthmaKidCare: How long will we need to stay
at the ER before they let me take my child home?
Dr. Chipps: The team at the ER will let you
take your child home when the symptoms that brought you there in the first
place have been properly addressed. Your child’s breathing should no longer be
labored. Peak flow readings should be greater than 60% of your child’s “best”
reading. And oxygen saturation in the blood should be above 94%. If severe
asthma symptoms were brought on by dehydration due to a stomach virus, your
child should not go home until vomiting and/or diarrhea has stopped and the
child is fully hydrated. Of course, any infection should be treated with an
antibiotic. And any evidence of a virus—such as edema (swelling) or excess
mucus—should have been addressed symptomatically.
AsthmaKidCare: Aren’t ER trips just a normal
part of childhood asthma?
Dr. Chipps: No, asthma symptoms that result
in a trip to the ER should not be considered “normal.” In my opinion, they
should be a rare occurrence. However, sometimes there are complications that
cannot be avoided — like an infection or an allergic reaction — that make it
impossible to avoid going to the ER.
AsthmaKidCare: How long will it take my child
to return to “normal” after a trip to the ER?
Dr. Chipps: It really depends on what
caused the emergency. For example, if it was an infection, it will take from
five to seven days for your child to get well. In all cases, it is very
important to strictly follow your child’s treatment plan after a trip to the
ER. Also, within one to three days after a session at the ER you should have
your child seen by his or her regular physician. Usually no change in the
treatment program is necessary. You just need to stick with the program you
already have.
AsthmaKidCare: How can we avoid going to the
emergency room at all?
Dr. Chipps: The best way to avoid trips to
the emergency room is to carefully follow the daily treatment plan outlined by
your doctor. But sometimes, even the most compliant patient can have
complications. A major infection from a cold or flu can bring on asthma
symptoms. Or a child can have an allergic reaction to something — a new
type of food, a seasonal allergen, or a medication — that can trigger
breathing problems. Dehydration — often due to prolonged vomiting or a
bout of diarrhea — is another condition that can bring on asthma
symptoms.
AsthmaKidCare: What kinds of things can
trigger severe asthma symptoms?
Dr. Chipps: A major infection from a cold
or flu. Or, a child can have an allergic reaction to something—a new type of
food, a seasonal allergen or a medication—that can trigger breathing problems.
Dehydration—often due to prolonged vomiting or a bout of diarrhea—is another
condition that can bring on asthma symptoms.
AsthmaKidCare: How can I be prepared for a
trip to the ER?
Dr. Chipps: While the goal of any asthma
treatment plan is to prevent symptoms and attacks, it’s a good idea to be
prepared in case of an emergency. Write down your child’s medical history.
Include all the medications your child takes, along with the dosages and the
way the medications are administered (oral or inhaled). Have your insurance
cards handy, along with the names and phone numbers of your child’s doctors.
Finally, make sure you know which ER in your area is the best one to go to with
a small child. If you’re out of town, find out where the ER facilities are
located.