Emergency department management of pediatric asthma

Abstract

For the physician providing acute care for children, knowledge of optimal management of pediatric asthma is essential. Asthma is one of the most common diseases of childhood, with a prevalence rate of 5.4% in the pediatric population, accounting for 17% of pediatric encounters in US emergency departments. Asthma is characterized by bronchial hyperreactivity, airway inflammation, and reversible airway obstruction. New developments in the understanding of the underlying physiology and pharmacologic treatment of pediatric asthma have occurred in recent years. Although inhaled beta-adrenergic agonists remain the initial treatment of choice for acute bronchospasm in asthma, there is increased understanding of the importance of inflammation in the disease process. There is also recognition of the role of cholinergic-mediated airway obstruction. This review focuses on the clinical applications of these concepts in the emergency management of pediatric asthma, the role of newer treatment modalities, and the value of implementing an emergency department management protocol.