Main Symptoms

• Don't use this guideline unless your child was previously diagnosed as having asthma, asthmatic bronchitis or reactive airway disease by a physician.
• The classic symptom is a wheeze or whistling (purring) sound on breathing out.

See More Appropriate Topic

• If no previous asthma diagnosis or use of asthma medicines, see WHEEZING.

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Call 911 Now (your child may need an ambulance)

• Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath).
• Your child passed out or has bluish lips/tongue.
• Wheezing started suddenly after medicine, an allergic food or bee sting. 

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.
• Looks like he did when hospitalized before with asthma.  
• Difficulty breathing not resolved 20 minutes after neb or inhaler.
• Peak flow rate lower than 50% of baseline level (personal best).  
• Peak flow rate 50-80% of baseline level after using neb or inhaler.
• Wheezing (heard across the room) not resolved 20 minutes after using neb or inhaler.
• Continuous (nonstop) coughing that keeps from playing or sleeping and not improved after using neb or inhaler.
• Asthma medicine (neb or inhaler) is needed more frequently than every 4 hours.
• Fever above 104°F (40°C).
• Severe chest pain.

Call Your Doctor Within 24 Hours (between 9 and 4) If

• You think your child needs to be seen.
• Lots of yellow or green nasal discharge now with a fever.
• Sinus pressure or pain.
• Fever present for more than 3 days.

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.
• Missing more than 1 day of school/month for asthma.
• Asthma limits exercise or sports.
• Asthma attacks frequently awaken from sleep.
• Uses more than 1 inhaler/month.
• Mild wheezing persists for more than 5 days.
• No asthma check-up in over 1 year.

Parent Care at Home

• Mild asthma attack and you don't think your child needs to be seen.

Home Care Advice for Asthma Attack

1. Asthma Medicine:
   
   Start the inhaler, nebs or oral asthma medicine at the first sign of any coughing or shortness of breath (don't wait for wheezing) (reason: early treatment shortens the asthma attack).
   
   The best "cough medicine" for a child with asthma is always the asthma medicine.  Continue the asthma medicine until your child has not wheezed or coughed for 48 hours.
   
   It takes a minimum of 7 days of medicine for lung function to return to normal.
   
   
2. Hay Fever:  For nose allergy symptoms, it's OK to give antihistamines.
   
   
3. Fluids:  Encourage a normal intake of clear fluids (e.g.,water) (reason: normal fluid intake keeps the lung mucus from becoming sticky).
   
   
4. Humidifier:  If the air is dry, use a humidifier (reason: to prevent drying of the upper airway).
   
   
5. Avoid or Remove Allergens:  Give a shower to remove pollens, animal dander, or other allergens from the body and hair.  Avoid known triggers of asthma attacks (e.g., tobacco smoke, feather pillows, exercise).
   
   
6. Expected Course:  If treatment is started early, most asthma attacks are quickly brought under control.  All wheezing should be gone by 5 days.
   
   
7. Call Your Doctor If:
   
   Inhaled asthma medicine (neb or inhaler) is needed more often than every 4 hours.
   
   Wheezing is not completely cleared by 5 days.
   
   Your child becomes worse or develops any of the "Call Your Doctor" symptoms.

Parent Care for Pediatric Symptoms. Copyright © 2000. Barton D. Schmitt, MD, FAAP

See related topics:

• Wheezing (other than Asthma)