Used when symptoms are present to relax the muscles that tighten the airways, and usually relieve asthma symptoms quickly
They do not control the asthma or prevent further attacks, but only treat acute symptoms
Controller Medications
Anti-inflammatory or long-acting bronchodilator
Used every day to prevent symptoms
The anti-inflammatory medications reduce the swelling or inflammation in the airways, thus making them less sensitive to the triggers and less likely to tighten or constrict. This leads to fewer and less severe asthma attacks
The long-acting bronchodilators are sometimes used along with the anti-inflammatory to help keep airways open in those patients with more severe asthma
Common Triggers
Colds or sinus infections
Indoor and outdoor allergens, like dust mites, pet dander, or pollen
Exercise
Irritants like cigarette smoke or fumes from paint, cleansers etc.
MDI Instructions
With Mask– Shake med, place in spacer, put mask on other end of spacer. Place mask on face, press inhaler down giving 1 puff. Let patient breathe 6-8 good breaths. Take mask off face. Give 30 sec before repeating process with the second puff
Without mask- Shake med, place in spacer, exhale completely, place spacer mouthpiece in mouth. Spray 1 puff, take a slow deep breath in until maximum inhalation reached and hold breath x 10 seconds. Let breath out after those 10 seconds. Give 30 sec before repeating process with the second puff
Treatment options if unresponsive to albuterol and trying to ward off intubation
Magnesium Sulfate (IV)
Fluid Bolus
Terbutaline (IV)
Ketamine (IV)
IM Epinephrine
Heliox
Bi-pap
Asthma Pathway
Inclusion criteria: patients age 2-18 years of age with acute asthma exacerbation
There are separate asthma pathway guidelines for patients in the ER, Floors, and in PICU
Patients on the pathway cannot “skip” stages when patient improving
For example: if your patient that is being admitted to the floor is scoring a 1 after coming off a continuous neb the next treatment given will be a Q2 treatment at either 10 or 15 mg based on weight
Patients on the pathway can “jump up” stages when patient worsening
Example: If a patient getting Q4 5mg nebs suddenly is scoring a 7, you would administer a continuous neb. If after the neb the score is back down, you would begin the step-down process again, starting with Q2 x 2
RT’s are responsible for writing all albuterol orders if the patient has an “albuterol titration protocol” order in Compass
Pay good attention to the exclusion criteria and educate physicians if patients erroneously ordered on pathway. Attending may need to be notified as well. examples of diagnoses not allowed on asthma pathway
Bronchiolitis
Cystic Fibrosis
Neuromuscular Disease
Immunodeficiency
Cardiac Disease
Other Chronic Lung Disease (unless otherwise specified)
Asthma Action Plan
All asthmatic patients must have an Asthma Action Plan (AAP) filled out before discharge and documented as such in the AD HOC education of the patient chart
AAP’s can and should be filled out in the ED
The form is available in English and Spanish
Asthma Education
Education should begin in the ED and continue throughout patients stay
All education needs to be documented in AD HOC each shift
There are informational booklets offered in English and Spanish, the RT should go over the information with the patient and family