Evaluation of treatment of the exacerbation of asthma and wheezing in a pediatric emergency department

Abstract

SUMMARY OBJECTIVES: To evaluate the treatment of wheezing and exacerbation of asthma in a pediatric emergency unit (ED), comparing it to that recommended by the guidelines for this purpose. METHODS: Descriptive cross-sectional study through medical records survey of children and adolescents (0–15 years of age) who received medication for wheezing or asthma exacerbation from January to April 2015 in the ED. The selected treatment was compared to that recommended by the guidelines, being analyzed the variables related to the medication (number and dose of short-acting β2 agonist, associated or not with anticholinergic, oral or parenteral corticosteroid) and the length of stay in ED (≤1 h, ≥8 h and hospital admission). RESULTS: One-thousand eleven patients were selected with 56.7% between 3 and 15 years and 56% male. Although the selected drugs were in accordance with what was recommended, errors were observed in relation to dose, drug of choice, and method and time of use with the most frequent finding being incorrect dose (short-acting β2 agonist: 66% and ipratropium bromide: 95.2%). CONCLUSION: The level of use of the measures recommended by the guidelines was low but compatible with other studies, leading to an increased risk of treatment failure and higher costs. Despite wide dissemination, the established concepts have not been sufficiently incorporated into clinical practice, suggesting the need for more effective educational actions for this process to occur.

Abordagem Do Paciente Pediátrico Com Exacerbação Asmática: Uma Revisão

“…O controle e manejo inadequado das crises de asma estão associados a morbidade significativa e impacto econômico, analisar e modificar essas barreiras à adesão as diretrizes de manejo e tratamento são essenciais para a evolução no manejo da doença (FILHO et al, 2020). É importante não confundir os critérios sintomáticos do agravamento da asma com a exacerbação, pois, a exacerbação de asma corresponde ao agravamento do estado crônico de obstrução, inflamação e espessamento das vias áreas.…”

“…Os corticosteróides são considerados o padrão-ouro para o tratamento da exacerbação asmática devendo ser utilizado na primeira hora sua utilização reduz as internações, reconsultas e gravidade. Seu uso oral é recomendado o mais precocemente possível, pois, independente da via escolhida são necessários pelo menos quatro horas para observar melhora clínica (FILHO et al, 2020).…”

“…A medicação preconizada nas diretrizes se trata do prednisolona oral e dexametasona intramuscular, a dose prescrita não foi analisada devido a frequente falta de registro do peso no prontuário, provavelmente calculado através de fórmulas. Mesmo que os estudos tenham mostrado que a dose não possui um grande impacto no tratamento de emergência, a utilização das doses recomendadas é de suma importância quando se considera seus efeitos adversos (FILHO et al, 2020).…”

Comment on “Evaluation of treatment of the exacerbation of asthma and wheezing in a pediatric emergency department”

“…A recent study entitled “Evaluation of treatment of the exacerbation of asthma and wheezing in a pediatric emergency department” 1 focused on how asthma exacerbations and wheezing are treated in a pediatric emergency department. The authors examined the treatment strategies used for children with conditions such as bronchodilators, corticosteroids, and other therapies.…”

“…First, the study 1 mainly analyzed the short-term outcomes such as the length of stay in the pediatric emergency unit. While this study provides valuable information about the initial response to treatment, it did not fully capture the long-term effects on patients and their overall prognosis.…”