Severe Acute and Life-Threatening Asthma in Children

Abstract

Asthma affects over 7 million children in the United States, and status asthmaticus is the most common pediatric medical emergency in the country. Asthma is a complex, multifactorial disease, and the risk factors for severe and life-threatening asthma exacerbations are similarly complex. In summary, a past history of a severe asthma exacerbation and poor asthma control are probably the two most portentous risk factors for future severe exacerbations. Acute severe asthma in children is a common cause of admission to the pediatric intensive care unit. Children with acute severe asthma require cardiorespiratory monitoring and stabilization that ensure that the treatment goals of adequate oxygenation and reversal of bronchial narrowing are achieved. For acute severe asthma, systemic corticosteroids should be given promptly; beneficial effect becomes evident at 1–3 h and maximal effects at 4–8 h after administration of the first dose in conjunction with administration of beta-agonists.