If your child doesn't respond well to treatment in the emergency department, the staff will arrange for admission to the hospital. In the past, this typically involved moving to a room upstairs in the hospital where care is supervised by your pediatrician or another physician.
Today some hospitals offer other options, such as "overnight" units that are attached to the emergency room and designed for short hospital stays.
Hospital treatment for asthma includes regular treatments with albuterol or another quick-relief medicine. These will be given close together initially and then gradually spaced to see if your child is able to move to a frequency that could be given at home. Again, don't be surprised if the doses given in the hospital are higher than what your doctor usually prescribes. Steroid medicines also are an important part of hospital treatment to reduce inflammation in the airways. Oxygen may be given if needed.
If your child is hospitalized for an asthma emergency, she will undoubtedly meet a number of new people. Nurse practitioners and physician assistants are taking on many of the day-to-day responsibilities of physicians. Respiratory therapists have specific training in asthma and lung diseases and provide inhaled medicines as well as other care. In many hospitals, respiratory therapists have an increasingly important role in assessing patients and teaching families about asthma and the use of medicines. Social workers and case managers may also be involved to plan appropriate services and asthma equipment for your child at discharge. A well planned team approach has been shown to be the most effective way to take care of asthma in the hospital, and the contribution of each of these health professionals is highly important. And because there's a lot of time available during any hospitalization, this is a good opportunity to ask the staff any questions and review your child's management plan.
In The Icu
Occasionally, a child may respond poorly to treatment and require admission to an intensive care unit. Asthma care in the ICU may include continuous albuterol treatments and intravenous medicines. Children with severe obstruction of their airways are unable to eliminate waste gases like carbon dioxide from the lungs. If these gases build up in the bloodstream, they'll cause a child to become sleepy. As a tired child spends less energy on breathing, the waste gas levels can continue to increase until breathing stops altogether. In these situations, insertion of a breathing tube (intubation) is needed, and the child will be placed on a ventilator. The use of a ventilator is difficult and has many potential complications. Fortunately, the need for this type of treatment is rare as new treatments for asthma have become available.
By the end of the next day, Robert was feeling much better. It had been over four hours since his last breathing treatment, and he was out in the playroom with the other children. After a discussion with a nurse practitioner on the asthma unit, Robert's parents realized that his lingering cough was a symptom of asthma. They learned that persistent symptoms, like the cough, can be controlled and prevented. The nurse practitioner also spoke with their family doctor, and they decided to prescribe a daily inhaled steroid. A follow up appointment was scheduled for later in the week to go over the use of the new medicine. With all this new information in hand, Robert's parents felt much better prepared to take control of his asthma in the future.
