Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit

Abstract

Asthma is the most common chronic disease of childhood, and acute exacerbations are a significant burden to patients and to public health. Optimal assessment and management of exacerbations, including appropriate escalation of interventions, are essential to minimize morbidity and prevent mortality. While inhaled albuterol and systemic corticosteroids are the mainstay of exacerbation management, escalation may include interventions discussed in this review.

Asthma, Food Allergy, and How They Relate to Each Other

“…Over time with advances in asthma medicine, management continues to change but treatment primarily focuses on assessment of asthma severity, the use of acute and chronic medications including bronchodilators, anti-inflammatory medication (i.e., steroids), and treatment of comorbidities (19). In the management of acute asthma, the goals are to reverse airflow obstruction, correct significant hypoxia, and prevent future relapses (20). In order to achieve this, management for acute exacerbations includes the use of oxygen, short-acting inhaled beta-agonists, ipratropium bromide, systemic corticosteroids, and magnesium sulfate.…”

Critical Issues in the Treatment of Pediatric Status Asthmaticus

“…The mode of delivery that works best remains a topic for discussion. greater efficacy, less tachycardia and tremor, and shorter ED times [10]. This recent data likely will not matter in the ICU setting because by the time the patient has been transferred to the ICU, the patient will have exhausted first line therapies.…”

“…It blocks cholinergic receptors and decreases parasympathetic tone, resulting in bronchodilatation. Ipratropium has been shown to be ineffective when used alone; however, when used with a SABA, ipratropium can improve lung function and reduce hospitalization rates in children with moderateto-severe exacerbations [10]. It is important to point out that ipratropium has only been shown to be effective in the emergency room setting.…”

“…In one randomized placebo-controlled trial, adding nebulized magnesium to combined nebulized bronchodilator and systemic steroid therapy failed to significantly shorten the time of discharge for pediatric patients with severe asthma [13]. While many studies have not shown a beneficial effect with the use of nebulized magnesium sulfate, intravenous MgSO 4 has been noted to improve pulmonary function and reduce hospitalization rates in children presenting with severe asthma exacerbations who fail to improve clinically following initial therapies [10]. Given this critical data, IV magnesium sulfate is an appropriate consideration to use as an adjunct therapy.…”

“…Heliox is an inert gas that is seven times less dense than air, and when mixed with oxygen, it may have sufficiently low density to convert airflow back to a laminar state [10]. Because of these properties, heliox increases the deposition of inhaled particles to the distal airways in patients with severe asthma, increasing the availability and efficacy of inhaled beta-agonists.…”