Management of acute severe asthma in children age over 1 year

Abstract

Introduction 15% of UK children have asthma and some (23 in 2002) still die during an acute exacerbation. There is evidence that some patients are not on optimum treatment and aggressive care can improve outcome. To improve management in our department a wheezy child care pathway was introduced which included a flow chart for management of acute severe asthma. Objectives To compare the management of patients with acute severe asthma admitted to HDU against revised British Thoracic Society Guidelines 2009 and identify areas for improvement. Methods Retrospective analysis of all patients admitted to HDU with acute wheeze over a period of 18 months. Results Total of 78 admissions, notes obtained for 45 admissions in 38 patients. Mean age was 60 months with a male preponderance. 54% were known asthmatics and 20% had previous HDU admission. All were treated with nebulised salbutamol, ipratropium bromide and oral/intravenous (IV) steroids in proper dose. 58% needed IV salbutamol and 15% were not given bolus dose. 44% developed hypokalemia and 97% developed hyperglycaemia on IV salbutamol. 60% were not seen by asthma nurse during admission. No proper documentation of whether written information was given or regular treatment was reviewed before discharge. Conclusion Audit identified areas for improvement and measures have been introduced to bring about change which included memo to staff about bolus dose of IV salbutamol and kit to make up IV salbutamol infusion (which includes 200 ml bag of 0.9% saline with 8 mmol KCl) to reduce hypokalemia and hyperglycaemia.