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Management of Children with Severe Asthma Exacerbation in the Emergency Department

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Abstract

Although acute asthma is a very common cause of emergency department visits in children, there is as yet insufficient evidence for the establishment of a standardized treatment protocol. The aim of this review is to describe updated information on the management of asthma exacerbations in the pediatric emergency department.

Oxygen is the first-line treatment of acute asthma exacerbations in the emergency department to control hypoxemia. It is accompanied by the administration of β2-adrenoceptor agonists followed by corticosteroids. β2-Adrenoceptor agonists have traditionally been administered by nebulization, although spacers have recently been introduced and proven, in many cases, to be as effective as nebulization.

Oral prednisolone, with its reliability, simplicity, convenience and low cost, should remain the treatment of choice for the most severe asthma exacerbations, when the lung airways are extremely contracted and filled with secretions. Recently, several studies have shown that high-dose inhaled corticosteroids are at least as effective as oral corticosteroids in controlling moderate to severe asthma attacks in children and therefore should be considered an alternative treatment to oral corticosteroids in moderate to severe asthma attacks.

Studies of other drugs have shown that ipratropium bromide may be given only in addition to β2-adrenoceptor agonists; theophylline has no additional benefit, and magnesium sulfate has no clear advantage.

Comprehensive asthma management should also include asthma education, measures to prevent asthma triggers, and training in the use of inhalers and spacers. Proper management will avoid most asthma attacks and reduce admission and readmission to emergency departments.

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The authors acknowledge that no sources of funding were used in the preparation of this manuscript and that there are no conflicts of interest.

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  1. Asthma Clinic, Schneider Children’s Medical Center of Israel, and Sackler School of Medicine, Tel Aviv University, 14 Kaplan Street, Petah Tikva, Tel Aviv, 49202, Israel

    Benjamin Volovitz & Moshe Nussinovitch

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Correspondence to Benjamin Volovitz.

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Volovitz, B., Nussinovitch, M. Management of Children with Severe Asthma Exacerbation in the Emergency Department. Pediatr-Drugs 4, 141–148 (2002). https://doi.org/10.2165/00128072-200204030-00001

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