Dr Michael Marcus: It’s a common question that I get and weather conditions by themselves really don’t affect asthma other than cold, dry air being a significant trigger for wheezing in patients with asthma. The thing about weather conditions and the thing about moving to different climates is much more related to the things that grow. And so, if you’re in the northeast, you have a certain type of pollen from the grass and the trees and the weeds that are common. If you move to someplace like Arizona, which is more hot and dry, the foliage and pollen in that area is very different. And so, if you hadn’t been exposed to that yet, you won’t have allergies to those things yet. But if you continue in those environments for a long period of time, eventually you develop allergies to those things and eventually the asthma symptoms return. Stead L, Whiteside T. Evaluation of a new EMS asthma protocol in New York City: a preliminary report. Prehosp Emerg Care. 1999 Oct-Dec;3(4):338-42.

It is difficult to match an asthma patient’s hyperventilation, and lower tidal volumes should be used to avoid barotrauma in the setting of hyperinflation. Finally, intravenous ketamine at doses starting at 2 mg/kg, is gaining favor as an adjunctive bronchodilator, especially for agitated patients in respiratory distress [8]. ReferencesPrior ED visits or hospitalizations for asthma (including intensive care unit admissions and/or intubations) With inhaled medications, we have different types of devices that can assist the child to use the medication in the best fashion, which will allow the medicine to reach the lungs to the best effect. And so using these assistant devices is an important piece that we add to a child’s therapy where it’s not always necessary in an adult’s therapy. Dr Michael Marcus: It’s interesting, but roaches and mice both produce a potent protein that can trigger the same type of inflammatory reaction that leads to the symptoms of asthma. And so early and high concentration of exposure to those things will give a child greater symptoms of their asthma conditions. First, the smooth muscle surrounding the bronchioles is stimulated by histamine and leukotriene, causing bronchoconstriction.

Dylla L, Acquisto NM, Manzo F, Cushman JT. Dexamethasone-Related Perineal Burning in the Prehospital Setting: A Case Series. Prehosp Emerg Care. 2018 Sep-Oct;22(5):655-658.Joey Wahler (Host): So how common is pediatric asthma? And is it any more or less prevalent than in years past? Mechanical ventilation may be necessary in rare cases. Non-invasive ventilation with bi-level positive airway pressure can help stave off intubation and preserves the conscious patient’s respiratory drive. Intubation and mechanical ventilation are the last resort for patients with refractory respiratory failure and/or respiratory arrest. EMS responds to a residence for a seven-year-old male with a cough and trouble breathing. This episode began two hours ago and has been accompanied by a runny nose without any other symptoms. His mother has been treating him with albuterol by a nebulizer, but he has progressively become more short of breath. Past medical history is notable for asthma since infancy, with multiple prior hospitalizations.