Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

Abstract

BackgroundAcute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department (ED) visit and hospitalization. Appropriate care is fundamental, considering both the high prevalence of asthma in children, and its life-threatening risks.Italian Society of Pediatrics recently issued a guideline on the management of acute asthma attack in children over age 2, in ambulatory and emergency department settings.MethodsThe Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was adopted. A literature search was performed using the Cochrane Library and Medline/PubMed databases, retrieving studies in English or Italian and including children over age 2 year.ResultsInhaled ß2 agonists are the first line drugs for acute asthma attack in children. Ipratropium bromide should be added in moderate/severe attacks. Early use of systemic steroids is associated with reduced risk of ED visits and hospitalization. High doses of inhaled steroids should not replace systemic steroids. Aminophylline use should be avoided in mild/moderate attacks. Weak evidence supports its use in life-threatening attacks. Epinephrine should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to β2 agonists. Intravenous magnesium solphate could be used in children with severe attacks and/or forced expiratory volume1 (FEV1) lower than 60% predicted, unresponsive to initial inhaled therapy. Heliox could be administered in life-threatening attacks. Leukotriene receptor antagonists are not recommended.ConclusionsThis Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2.

Astim Alevlenmesi̇nde Kullanilan İlaçlar

“…Tüm incelemeler sonucunda yüksek doz İKS'lerin sistemik steroidler yerine kullanılmaması ve alevlenme sürecinde alınmakta olan İKS tedavisine ara verilmemesi önerilmektedir (2,32).…”

“…IV KEBA kullanımı ile çocuklarda yapılan çalışma çok azdır (32). Bazı araştırmacılar başlangıç tedavisine yanıtı iyi olmayan ağır alevlenmesi olan çocuklarda UEBA tedavisine ek olarak IV salbutamol önermektedirler ancak ağır astım alevlenmelerinde rutin IV KEBA kullanımını destekleyen kanıt yoktur (Kanıt A) (2,58).…”

“…Yan etkilerinin fazla olması da (özellikle hipoksemik hastalarda) istenmeyen özelliğidir. Sadece KEBA kullanamayan hastalarda bir seçenek olabilir (2,32).…”

“…Oksijen uygulaması yerine rutin kullanımının faydası yoktur (Kanıt B). Başlangıç tedavisine yanıtı olmayan ağır astım alevlenmelerinde oksijene alternatif olarak kullanılabilir (2,32).…”

Mathematical evaluation of the efficacy of montelukast in pediatric patients with asthma

“…не рекомендуется добавление монтелукаста к стандартной терапии обострения БА [15]. Данное утверждение основано на результатах обзора Cochrane, в котором не было обнаружено статистически значимого снижения риска госпитализации при применении перорального монтелукаста в дополнение к стандартной терапии [16].…”