Abstract
Acute asthma or wheeze is a common presentation to emergency services for both adults and children. Although there are phenotypic differences between asthma syndromes, the management of acute symptoms follow similar lines. This article looks at the similarities and differences in approaches for children and adults. Some of these may be age dependent, such as the physiological parameters used to define the severity of the attack or the use of age appropriate inhaler devices. Other differences may reflect the availability of evidence. In other areas there is conflicting evidence between adult and pediatric studies such as a temporary increase in dose of inhaled corticosteroids during an acute attack. Overall there are more similarities than differences.
Highlights
Asthma is the commonest chronic condition in the UK with a UK lifetime prevalence of patient-reported clinician-diagnosed asthma of 15.6%
There is relatively little evidence compared to other intravenous therapies there is one comparative study showing a more rapid improvement compared to IV salbutamol or aminophylline [32]. It is generally safe with few side effects. It should be used if there is a poor response to first line therapies and is not recommended in mild to moderate asthma attacks
Aminophylline was previously considered the first line IV treatment following a poor response to initial management but intravenous magnesium is recommended as first line due to reduced side effects and equal efficacy [2]
Summary
Reviewed by: Giuseppe Pingitore, ASL Roma, Italy Yusei Ohshima, University of Fukui, Japan. Acute asthma or wheeze is a common presentation to emergency services for both adults and children. There are phenotypic differences between asthma syndromes, the management of acute symptoms follow similar lines. This article looks at the similarities and differences in approaches for children and adults. Some of these may be age dependent, such as the physiological parameters used to define the severity of the attack or the use of age appropriate inhaler devices. Other differences may reflect the availability of evidence. In other areas there is conflicting evidence between adult and pediatric studies such as a temporary increase in dose of inhaled corticosteroids during an acute attack. Overall there are more similarities than differences
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