Abstract
Acute severe asthma is one of the most common medical emergency situations in childhood, and physicians caring for acutely ill children are regularly faced with this condition. In this article we present a summary of the pathophysiology as well as guidelines for the treatment of acute severe asthma in children. The cornerstones of the management of acute asthma in children are rapid administration of oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled bronchodilators may include selective b2-agonists, adrenaline and anticholinergics. Additional treatment in selected cases may involve intravenous administration of theophylline, b2-agonists and magnesium sulphate. Both non-invasive and invasive ventilation may be options when medical treatment fails to prevent respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.
Highlights
Asthma is the most common chronic disease of childhood in the western countries, and the incidence has continuously been rising during the last decades [1]
Physicians who care for acutely ill children will regularly be faced with acute severe asthma
We performed a thorough search in PubMed with the following words in different combinations; asthma, children, severe, attack, exacerbation, epidemiology, pathophysiology, guidelines, treatment, management, oxygen, adrenaline, b2-agonist, anticholinergics, theophylline, steroids, magnesium, helium, CPAP, bilevel positive airway pressure (BiPAP), ventilation
Summary
Asthma is the most common chronic disease of childhood in the western countries, and the incidence has continuously been rising during the last decades [1]. The majority of children with asthma have stable disease, and only a minority experience exacerbations needing hospitalisation or emergency room visits. Recent advances in treatment seem to have reduced chronic morbidity as well as the number of acute exacerbations [3,4]. Viral wheeze is a very common clinical scenario in young children, and identification and proper treatment of subjects with potential for development of asthma and future exacerbations is still an unresolved challenge [5]. In all age groups, failure of adherence to regular anti-inflammatory treatment schemes may be an important reason why acute asthma is still a common cause of unscheduled hospitalisations in childhood. Physicians who care for acutely ill children will regularly be faced with acute severe asthma
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