Relieve Childhood Asthma with The Bowen Technique
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Referral in an Acute Brochial Asthma Attack
Written by Bernard Garrett.   Published on 29 November 2002.

Introduction

The aim of this short piece is to emphasis the importance of referral with respect of an acute exacerbation (attack) of bronchial asthma. Referral could be defined as;

"Clinical referral to another practitioner who is better able to manage the patient at that particular point in time"

Background

Acute exacerbation (attack) of bronchial asthma is the commonest reason for a child to be admitted to hospital in the UK. Between 1970 - 1986 a seven-fold increase of children 0 - 4 years, and a triple increase of children aged 5 - 15 years was recorded for asthma related hospital admissions. During the early 1990's child asthma admissions represented between 10 - 20% of all medical admissions. Thankfully such figures have decreased over recent years, however family doctor consultations with respect of child asthma have doubled in the last 15 years. The prevalence of asthma in children appears to have increased. Most disturbing is a review of children deaths in 1998 for England & Wales during which 24 children died secondary to an acute episode of asthma. (Advanced Paediatric Life Support, 2001)

Adult death secondary to bronchial asthma is also reported, it is estimated that 100,000 people young and old throughout the world die needlessly of asthma each year. (Tan, 2000) Yet acute exacerbation of bronchial asthma is largely a reversible condition and therefore death is avoidable. Tan, (2000) describes this appalling finding as "the ultimate measure of management failure". UK analysis of events leading to adult death secondary to bronchial asthma highlight that death occurred mostly out of hospital, with common accompanying factors. The patient, persons present, including medical practitioners, did not always recognise the SEVERITY of the attack and subsequently delayed seeking advanced medical attention UNTIL IT WAS TOO LATE. (Advanced Life Support, Provider Manual, 2000)

Rattray, A (2002) advises that in the event of encountering a child experiencing a major asthma attack that the emergency services should be immediately summoned. The Bowen Asthma emergency procedure is then offered and completed if child and guardian give consent. The procedure is completed while emergency services are on route. This is a classic example of timely clinical referral and safe practice.

Can the practitioner be distracted into thinking the asthma attack is not really so severe? Unfortunately yes. Please consider the stoicism so often shown by a sick child, and the older child who bravely states; "I will be OK" and so on. The guardian(s) may not appreciate the degree of severity " It is not as bad as last time" and so on. Albeit just a few instances, but they illustrate how the practitioner's decision-making could be deviated into thinking, perhaps it is not as bad as I first thought? Looking now to those unfortunate guardians and medical practitioners who have suffered the loss of a child to asthma. They may have initially felt that the asthma attack would soon abate and that treatment given at the scene would remedy the situation, only to witness deterioration a little later. I am sure that such persons had the child's best interest at heart and they will never forget the event. The key lesson they have given us is to seek expert medical help immediately.

The Rattray (2002) 'protocol' minimises practitioner distraction in making the decision to refer a child for medical assistance. (In a major asthmatic attack, call the emergency services immediately) As acute bronchial asthma is dynamic, either getting better or getting worse, may I suggest that all acute asthmatic / breathing difficulty episodes in children be medically referred, with Bowen moves administered in the interim while awaiting the arrival of the emergency services.

(In a major asthmatic attack / breathing difficulty, call the emergency services immediately)

Summary

It is important to reflect that in many medical emergencies, the early stages often present with mild features of ill health, before things get clinically out of hand. Therefore it is wise to refer early. The incidence of asthma has increased and it is very important to have research completed into the efficacy of Bowen so that its clinical contribution to helping asthmatic children be evaluated and published. To that end I wish Alastair Rattray well in his research to evaluate the Bowen contribution to helping 'little ones' overcome the acute and chronic effects of bronchial asthma. Finally to finish is a list of some clinical features often present when the asthmatic child who is ill is in grave danger.

Refer the child early before:

Some features of SEVERE bronchial asthma:
· Too breathless to feed or talk
· Chest recession (collapsing)
· Use of accessory muscles of respiration
· Respiratory rate above 50 per min
· Pulse rate above 140 per minute
· Peak Flow reading 50% of expected best

Some features of LIFE THREATENING bronchial asthma :

· Conscious level depressed /child agitated
· Exhaustion
· Poor Respiratory effort
· Cyanosis (lips going blue for example)
· Peak Flow reading 33% of expected best
· Silent chest

Potential sequel:

· Respiratory arrest
· Cardiac Arrest
· Death

(Data Modified - Advanced Paediatric Life Support, 2001)

Bernard Garrett (2002)
Senior Lecturer (Nursing) whose specialist experience is in Accident & Emergency in the UK. Bernard is also a qualified Bowen Therapist.

References:

Advanced Life Support (2000) Provider Manual. (4th Edition) FiSH Books

Advanced Paediatric Life Support (2001) The Practical Approach. (3rd Edition)
BMJ Books

Rattray, A. (2002) Relieve Childhood Asthma.
http://www.relieve-childhood-asthma.com/emergency.html (accessed 24 - 10 - 2002)

Tan, W.C. (2000) Global Perspectives on Asthma Deaths.
http://www.findarticles.com (accessed 24 - 10 - 2002)


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