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  • Asthma Attack


    • Your child is having an asthma attack
    • Use this guide only if a doctor has told you your child has asthma

    First Aid for Anaphylaxis – Epinephrine

    • Anaphylaxis is a life-threatening allergic reaction.
    • If you have epinephrine (such as Epi-pen), give it now.
    • Do this while calling 911.
    • Over 66 pounds (30 kg): Give 0.3 mg. Epi-Pen.
    • 33-66 pound (15-30 kg): Give 0.15 mg. Epi-Pen Jr.
    • Less than 33 pounds (15 kg): Give dose advised by your doctor.
    • Give the shot into the upper outer thigh in the leg straight down.
    • Can be given through clothing if needed.
    • Albuterol inhaler: After giving the Epi-pen, give 4 puffs from your asthma inhaler.
    • Benadryl: After giving the Epi-pen, also give Benadryl by mouth. Do this if your child is able to swallow.


    • Symptoms of an asthma attack are wheezing, a cough, tight chest, and trouble breathing.
    • Wheezing is the classic symptom. Wheezing is a high-pitched whistling or purring sound. You can hear it best when your child is breathing out.

    Causes (Triggers) of Asthma Attacks

    • Infections that affect breathing (like colds or the flu)
    • Pollens
    • Animals (like cats)
    • Tobacco smoke
    • Irritants (such as smog, car exhaust, menthol vapors, barns, dirty basement)
    • Asthma attacks caused by food allergy can be life-threatening

    Pain Scale

    • Mild: No Shortness of Breath (SOB) at rest. Mild SOB with walking. Can talk normally. Speaks in sentences. Can lay down flat. Wheezes not heard. (GREEN Zone: Peak Flow Rate 80-100% of normal rate)
    • Moderate: SOB at rest. Speaks in phrases. Wants to sit (can’t lay down flat). Wheezing can be heard. (YELLOW Zone: Peak Flow Rate 50-80% of normal rate)
    • Severe: Severe SOB at rest. Speaks in single words. Struggling to breathe. Wheezing may be loud. (RED Zone: Peak Flow Rate less than 50% of normal rate)

    When to Call Us for Asthma Attack

    Call 911 Now (your child may need an ambulance) If:

    • Wheezing and life-threatening allergic reaction to similar substance in the past
    • Starts to wheeze suddenly after taking medicine, an allergic food or bee sting
    • Severe trouble breathing (struggling for each breath, can barely speak or cry)
    • Passed out
    • Lips or face are bluish when not coughing
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Your child looks or acts very sick
    • Looks like he did when hospitalized before with asthma
    • Lips or face have turned bluish during coughing
    • Trouble breathing not gone 20 minutes after neb or inhaler
    • Peak flow rate less than 50% of normal rate (RED Zone)
    • Peak flow rate 50-80% of normal rate after using neb or inhaler (YELLOW Zone)
    • Wheezing (heard across the room) not gone 20 minutes after using neb or inhaler
    • Nonstop coughing not improved after using neb or inhaler
    • Severe chest pain
    • Need to use asthma medicine (neb or inhaler) more often than every 4 hours
    • Fever over 104° F (40° C)
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Mild wheezing lasts over 24 hours on treatment
    • Sinus pain (not just congestion)
    • Fever for more than 3 days
    • Fever returns after gone for more than 24 hours

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • Don’t have written asthma action plan from your doctor
    • Use an inhaler, but don’t have a spacer
    • Miss more than 1 day of school per month for asthma
    • Asthma limits exercise or sports
    • Asthma attacks wake child up from sleep
    • Use more than 1 inhaler per month
    • No asthma check-up in over 1 year

    Parent Care at Home If:

    • Mild asthma attack

    Care Advice for Asthma Attack

    What you should know:

    • Over 10% of children have asthma.
    • Your child’s asthma can flare up at any time.
    • When you are away from your home, always take your child’s medicines with you.
    • The sooner you start treatment, the faster your child will feel better.
    • Here is some care advice that should help.

    Asthma Quick-Relief Medicine:

    • Your child’s quick-relief (rescue) medicine is albuterol or xopenex.
    • Start it at the first sign of any wheezing, shortness of breath or hard coughing.
    • Give by inhaler with a spacer (2 puffs each time) or use a neb machine.
    • Repeat it every 4 hours if your child is having any asthma symptoms.
    • Never give it more often than 4 hours without talking with your child’s doctor.
    • Coughing. The best “cough med” for a child with asthma is always the asthma medicine. (Caution: don’t use cough suppressants. If over 6 years old, cough drops may help a tickly cough.)
    • Caution: If the inhaler hasn’t been used in over 7 days, prime it. Test spray it twice into the air before using it for treatment. Also, do this if it is new.
    • Use the medicine until your child has not wheezed or coughed for 48 hours.
    • Spacer. Always use inhalers with a spacer. It will get twice the amount of medicine into the lungs.

    Asthma Controller Medicine:

    • Your child may have been told to use a controller drug. Examples are inhaled steroids or cromolyn.
    • During asthma attacks, keep giving this medicine to your child as ordered.

    Hay Fever:

    • For signs of nasal allergies (hay fever), it’s okay to give allergy medicine. Reason: Poor control of nasal allergies makes asthma worse.


    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • Reason: It will loosen up any phlegm in the lungs. Then it’s easier to cough up.


    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.

    Avoid or Remove Allergens:

    • Shower to remove pollens or other allergens from the body and hair.
    • Avoid known causes of asthma attacks (such as smoke or cats).
    • Do not take part in sports during the attack.

    What to Expect:

    • If treatment is started early, most asthma attacks are quickly brought under control.
    • All wheezing should be gone by 5 days.

    Call Your Doctor If:

    • Trouble breathing occurs
    • Asthma quick-relief medicine (neb or inhaler) is needed more than every 4 hours
    • Wheezing lasts over 24 hours
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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