Skip to main content
SpringerLink
Log in

Management of Acute Asthma in Children

  • Review Article
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Asthma is the most common disease of childhood globally and acute asthma is the most significant risk factor for asthma-related death and chronic complications. This article will aim to synthesize the most up-to-date research and translate it into a more practical guide to managing acute asthma on a more daily basis. The use of clinical severity score is reviewed alongside the use of history and clinical findings in making objective assessments of patients presenting with acute asthma. Practical evidence-based pathways and a stepwise approach are provided for management of acute asthma in the home, outpatient, emergency, and intensive care settings. In doing so, popular myths are dispelled and practices in relation to management of acute asthma and use of asthma related medications are clarified. Having a standardized approach to management of acute asthma will bring us one step closer to reducing exacerbations and achieving the goal of having zero tolerance towards exacerbations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pardue Jones B, Fleming GM, Otillio JK, Asokan I, Arnold DH. Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit. J Asthma. 2016;53:607–17.

    Article  CAS  Google Scholar 

  2. Kumar P, Ram U. Patterns, factors associated and morbidity burden of asthma in India. PLoS One. 2017;12:e0185938.

  3. O'Byrne PM, Pedersen S, Lamm CJ, Tan WC, Busse WW. START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179:19–24.

  4. Global Initiative For Asthma. GINA Report, Glob Strat Asthma Manag Prevention. 2021. Available at: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Accessed on 20 July 2021.

  5. Moriates C, Feldman L. Nebulized bronchodilators instead of metered-dose inhalers for obstructive pulmonary symptoms. J Hosp Med. 2015;10:691–3.

    Article  Google Scholar 

  6. Sears MR, Rea HH, Fenwick J, Gillies AJ, Holst PE, O’Donnell TV, Rothwell RP. 75 deaths in asthmatics prescribed home nebulisers. Br Med J (Clin Res Ed). 1987;294:477–80.

    Article  CAS  Google Scholar 

  7. Jackson DJ, Bacharier LB, Mauger DT, et al. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations. N Engl J Med. 2018;378:891–901.

    Article  CAS  Google Scholar 

  8. Gregory S, Kenan H. Acute asthma exacerbations in children younger than 12 years: Overview of home/office management and severity assessment. In: UpToDate. 2021. Available at: https://www.uptodate.com/contents/acute–asthma–exacerbations–in–children–younger–than–12–years–emergency–department–management#H43. Accessed on 5 July 2021.

  9. Qureshi F, Pestian J, Davis P, Zaritsky A. Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med. 1998;339:1030–5.

  10. Wei J, Lu Y, Han F, Zhang J, Liu L, Chen Q. Oral dexamethasone vs. oral prednisone for children with acute asthma exacerbations: a systematic review and meta-analysis. Front Pediatr. 2019;7:503.

  11. Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Paediatr Respir Rev. 2013;14:234–5.

    PubMed  Google Scholar 

  12. Shan Z, Rong Y, Yang W, et al. Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: a systematic review and meta-analysis. Respir Med. 2013;107:321–30.

    Article  Google Scholar 

  13. Qureshi F, Zaritsky A, Welch C, Meadows T, Burke BL. Clinical efficacy of racemic albuterol versus levalbuterol for the treatment of acute pediatric asthma. Ann Emerg Med. 2005;46:29–36.

    Article  Google Scholar 

  14. Wade A, Chang C. Evaluation and treatment of critical asthma syndrome in children. Clin Rev Allergy Immunol. 2015;48:66–83.

    Article  CAS  Google Scholar 

  15. Wong JJ, Lee JH, Turner DA, Rehder KJ. A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children. Expert Rev Respir Med. 2014;8:423–41.

    Article  CAS  Google Scholar 

  16. Doymaz S, Schneider J, Sagy M. Early administration of terbutaline in severe pediatric asthma may reduce incidence of acute respiratory failure. Ann Allergy Asthma Immunol. 2014;112:207–10.

    Article  CAS  Google Scholar 

  17. Howell JD. Acute severe asthma exacerbations in children younger than 12 years : Intensive care unit management. UptoDate. 2021. Available at: https://www.uptodate.com/contents/acute-severe-asthma-exacerbations-in-children-younger-than-12-yearsintensive-care-unit-management. Accessed on 24 July 2021.

  18. Chao KY, Chien YH, Mu SC. High-flow nasal cannula in children with asthma exacerbation: A review of current evidence. Paediatr Respir Rev. 2021;40:52–7.

  19. Kline-Krammes S, Patel NH, Robinson S. Childhood asthma: a guide for pediatric emergency medicine providers. Emerg Med Clin North Am. 2013;31:705–32.

    Article  Google Scholar 

  20. Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs in Context. 2021;10. https://doi.org/10.7573/dic.2020-12-7

  21. Saglani S, Fleming L, Sonnappa S, Bush A. Advances in the aetiology, management, and prevention of acute asthma attacks in children. Lancet Child Adolesc Health. 2019;3:354–64.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. West Midlands Deanery, Health Education England (West Midlands), Health Education England, West Midlands, Birmingham, UK

    Siddharth Mahesh

  2. Division of Pediatric Pulmonology and Sleep, Department of Pediatrics, KTPNUCMI, National University Hospital, Singapore, 119228, Singapore

    Mahesh Babu Ramamurthy

  3. Department of Pediatrics, YLLSOM, National University of Singapore, Singapore, Singapore

    Mahesh Babu Ramamurthy

Authors
  1. Siddharth Mahesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahesh Babu Ramamurthy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SM: Manuscript writing and editing; MBR: Overall concept, manuscript writing, and editing. MBR will act as the guarantor for this paper.

Corresponding author

Correspondence to Mahesh Babu Ramamurthy.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahesh, S., Ramamurthy, M.B. Management of Acute Asthma in Children. Indian J Pediatr 89, 366–372 (2022). https://doi.org/10.1007/s12098-021-04051-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-021-04051-6

Keywords

Search

Navigation