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MILD ASTHMA ATTACK IN CHILDHOOD
I asked Simon to describe to me how he felt during an asthma attack:
I always seem to get them before I go back to school – or at least my Mum and Dad say I do. I remember waking up in the night and I suddenly found I was itching. At first I didn’t know what was making me itchy but suddenly I noticed a lot of white and red spots all over my body. When I was itching I really caught one and it hurt a lot. I felt very hot as if I was in a train boiler. I felt very weak and tired and then I started to cough. I couldn’t stop and my Mum came in and shouted, ‘Stop that coughing, you’ll waken everyone else.’ I tried to hold my breath so as I wouldn’t cough but I found that my breathing was worse than usual. I needed the toilet but when I got out of bed and tried to walk I found I couldn’t breathe. I felt very depressed and started to cry. My Mum came then and said that I was having an asthma attack and needed my inhaler. I took two puffs of my inhaler and soon I felt a lot better although my hands wouldn’t stop shaking. I couldn’t sleep so my Mum stayed with me the rest of the night.
This describes one of Simon’s early attacks, and now he is well able to recognize when his wheezing is going to start. At the time I was treating him with a standard Ventolin pressurized inhaler, which was effective at relieving the wheezing but gave Simon the irritating side-effect of shaking characteristic of Ventolin. His parents were very worried by it, so I changed him to a Bricanyl inhaler. Next time I saw him at the asthma clinic he commented that the Bricanyl made him seem very weak and he always had to lie down after it. He had also found that if he used it at school he was unable to concentrate on his lessons. I had not heard of this previously with Bricanyl so wondered if it was really a facet of the asthma rather than the treatment. However, at his next appointment Simon still complained of tiredness and said he much preferred the shaking with the Ventolin – it only bothered his parents, not him. Often in illnesses children seem to know naturally what is right for them, so I changed Simon back to the Ventolin. Although he developed the shakes again he was quite happy and not tired or lethargic.
Simon was a classic example of how important it is to monitor asthma with a peak flow meter. When he was perfectly well and had been free of any wheezing for a few weeks his peak flow measurement was around the 450 mark. When I saw him after school one day when he had developed asthma following a run, his peak flow was down to 330, indicating a reasonable degree of constriction of the airways. Ten minutes after taking two puffs on his inhaler it had risen to 390. Simon was very happy with this and felt much better, but really he still had some way to go to a full return to normal.
I checked Simon’s inhaler technique and there was no doubt he was rushing the process and not allowing the medication sufficient time to be absorbed into his lungs before breathing out. I told him to breathe slower and this time his peak flow rose to 420, better, but still 30 short of his maximum.
One of Simon’s friends at school had shown him his diskhaler, which Simon thought looked good fun and I then wondered if inhaling a powder would improve his peak flow. Sure enough, with one single measured dose, roughly equivalent to the two puffs he had been taking, the peak flow reading returned to its normal of 450. Simon went away very pleased with his new toy and looking forward to showing it off at school.
Only by measuring Simon’s peak flow could we tell that his lungs were not functioning normally. I cannot stress enough the use of the peak flow meter in the treatment of both mild and severe asthma, as it shows quite objectively whether the situation is improving or becoming worse. As the child becomes older the readings can be used to gain valuable time in treatment and also to assess how severe the attack is likely to be.
*45/211/5*