Atrovent (Ipratropium Bromide)

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CHILDHOOD ASTHMA: TREATMENT OF A MILD ATTACK
Asthma attacks can be mild – an irritating cough or wheeze but the child is not ill – or they can be more severe, causing increasing shortness of breath. The mild and severe attacks do seem to be two separate conditions, with a mild attack not necessarily leading on to a severe one.
David is an 8 year old who has gradually developed asthma since the age of 5. His parents noticed he would occasionally wake in the night with a slight wheeze, which also occurred when he climbed hills. (During the sleeping hours the airways do close down a little, so any tendency to develop asthma is accentuated at night.)
Pressurized aerosols which can be carried around with the child are very much the best treatment for mild attacks. Initially I had prescribed David a Ventolin inhaler, but he had some problems coordinating his breathing, so I switched him to a Bricanyl turbohaler. This produced a dramatic improvement and quickly relieved his wheezing with a single puff. I loaned him a peak flow meter to try and discover the severity of the condition. David’s normal peak flow reading was 400.
I asked him to repeat this the next time he became wheezy, and one morning the following week he woke up with an irritating cough and slight shortness of breath. This time when blowing into the machine the counter only reached 310, a 23 per cent reduction in his breathing capacity; this was sufficient to cause him to cough and have a slight wheeze. He repeated the reading two minutes after a slowly breathed in puff on his inhaler, and the reading had risen to 375; his breathing felt completely normal at this level. When he showed me these results at his next visit to the asthma clinic I decided to be a perfectionist and advised David to try two puffs instead of one. This extra dose returned his peak flow reading to 400, his usual healthy level.
The use of a bronchodilator inhaler in this way is the simplest form of treatment, other than sitting down and resting. It is all that many asthmatics ever need, to them the inhaler can be their best friend. I had told David’s parents when I saw them on their own one day that they must not give him the impression that they were very worried about his attacks; if they behaved as if these mild wheezing episodes were almost a part of normal everyday living, and then David himself would not become stressed or frightened by them. This is a very important part of managing asthma – and as it transpired David never picked up any of the emotional traumas of asthma at all.
In the majority of cases, therefore, the therapy for a mild asthma attack is very straightforward – two or three puffs on a pressurized bronchodilator inhaler and a check on the peak flow meter that the lung capacity has returned to normal. Unfortunately, there are occasions when treatment may not be that easy – even for very mild attacks – so it is worth looking at some other cases to see the different situations that arise.
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