🫁 Pediatric Asthma & Cystic Fibrosis
One narrows the airway reversibly; the other thickens every secretion in the body. Plus the silent chest that means arrest is coming.
💨 Asthma
Three things happen at once: bronchospasm, airway inflammation, and mucus plugging. All three are reversible — which is what separates asthma from COPD.
| Sign | Note |
|---|---|
| Expiratory wheeze | Air trapped behind narrowed airways |
| Prolonged expiration | Getting air out is the problem, not in |
| Retractions, nasal flaring | Work of breathing |
| Tripod position | Maximizing accessory muscles |
| SILENT CHEST | No wheeze because no air is moving — impending arrest |
A silent chest is NOT improvement. A child who stops wheezing but is working harder, drowsy or cyanosed is deteriorating toward respiratory arrest. Escalate immediately.
✅ The two drug groups — do not mix them up
| RESCUE | CONTROLLER | |
|---|---|---|
| Drug | Short-acting beta-2 agonist — albuterol/albuterol | Inhaled corticosteroid — fluticasone, budesonide |
| When | During an attack | Every day, even when well |
| Effect | Works in minutes | Takes weeks; prevents attacks |
| Side effects | Tachycardia, tremor, jitteriness | Oral thrush — rinse the mouth after |
A steroid inhaler will not help during an attack, and a rescue inhaler will not prevent one. Children who use the rescue inhaler more than twice a week need their controller reviewed.
If both are due, give the bronchodilator FIRST — it opens the airways so the steroid can reach further down.
💉 Teaching that gets tested
- Use a spacer — far better delivery in children
- Rinse the mouth after inhaled steroids — prevents thrush
- Peak flow monitoring: green 80–100% of personal best, yellow 50–80% (caution), red under 50% (emergency)
- Identify and avoid triggers: exercise, cold air, smoke, pets, dust, pollen, viral infections
- Pre-treat before exercise if exercise is a trigger — sport is not forbidden
🥚 Cystic fibrosis
A defective chloride channel makes every exocrine secretion thick and sticky. Autosomal recessive.
Thick mucus blocks airways. Thick pancreatic secretions block enzymes from reaching the gut. That is the whole disease.
⭐ Diagnosis
Sweat chloride test — above 60 mEq/L is diagnostic.
Parents often report the baby “tastes salty” when kissed. Many are picked up on newborn screening, or by meconium ileus at birth.
| System | Problem | Care |
|---|---|---|
| Lungs | Thick mucus, chronic infection, bronchiectasis | Airway clearance BEFORE meals; chest physio, nebulizers, antibiotics |
| Pancreas | Enzymes cannot reach the gut → malabsorption | Pancreatic enzymes with EVERY meal and snack |
| Stools | Steatorrhoea — bulky, greasy, foul, floating | Enzyme dose is titrated to stools |
| Growth | Poor weight gain despite big appetite | High-calorie, high-protein diet; fat-soluble vitamins A, D, E, K |
| Sweat | Loses excess salt | Extra salt in hot weather or with exercise |
Airway clearance goes BEFORE meals, not after - doing it on a full stomach causes vomiting.
Enzymes must be taken WITH food. Taken without food they do nothing, because there is nothing to digest.
Children with CF need MORE calories, not fewer — often 1.5 times the normal requirement — because they malabsorb and work harder to breathe. A high-fat, high-calorie diet is correct here even though it sounds wrong.
🎯 NCLEX traps
- Silent chest = emergency, not improvement
- Bronchodilator before steroid inhaler; rinse the mouth after
- Peak flow red zone under 50%
- Sweat chloride over 60 diagnoses CF
- Enzymes with every meal; physio before meals
- CF needs extra salt and extra calories