Drug Therapy Approaches in the Treatment of Acute Severe Asthma in Hospitalised Children

Abstract

Acute severe paediatric asthma remains a serious and debilitating disease throughout the world. The incidence and mortality from asthma continue to increase. Early, effective and aggressive outpatient therapy is essential in reducing symptoms and preventing life-threatening progression. When complications occur or when the disease progresses to incipient respiratory failure, these children need to be managed in a continuous care facility where aggressive and potentially dangerous interventions can be safely instituted to reverse persistent bronchospasm. The primary drugs for acute severe asthma include oxygen, corticosteroids, salbutamol (albuterol) and anticholinergics. Second-line drugs include heliox, magnesium sulfate, ketamine and inhalational anaesthetics. Future therapies may include furosemide, leukotriene modifiers, antihistamines and phosphodiesterase inhibitors. This review attempts to explore the multitude of medications available with emphasis on pharmacology and pathophysiology.

The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study

“…The effect produced by the administration of magnesium might have resulted from partial or total impedance of muscle endplate depolarization, possibly influenced by the lessened amounts of acetylcholine released from the nerve endings. In this way, it inhibits both smooth and skeletal muscle contraction and slows neurological transmission (19). Furthermore, magnesium changes the membrane transport mechanism in a similar way to local anaesthetics (5).…”

An aerosol formulation of R-salbutamol sulfate for pulmonary inhalation

“…For patients with severe asthma, the long-term effects of inhaling racemic salbutamol can cause adverse effects, including nervousness, tremor and chest pain 17 . In controlled trials R -salbutamol caused a slightly lower incidence of nervousness than racemic salbutamol and smaller increases in heart rate 18 . S -isoprenaline and S -terbutaline, which are also used for the treatment of asthma, were also shown to evoke airway hyperresponsiveness 8 .…”

Biochemical and immunohistochemical examination of the effects of ephedrine in rat ovary tissue

“…EPH is usually used in nonsevere asthma, to control chronic asthma rather than to treat acute seizures. EPH is also used in the symptomatic treatment of reversible bronchospasms associated with chronic bronchitis, emphysema and bronchospastic respiratory disorders 8 . EPH has been shown to increase energy expenditure and cause the loss of body fat in rats and mice 9 .…”