Treatment Of Acute Asthma Exacerbations Research Articles

Chinese expert consensus on the application of the Internet of Things as assistive technology for the diagnosis and treatment of acute asthma exacerbations

Chinese expert consensus on the application of the Internet of Things as assistive technology for the diagnosis and treatment of acute asthma exacerbations

248 Analysis of Albuterol Prescriptions Written by Emergency Medical Providers for the Treatment of Pediatric Patients With Acute Asthma Exacerbation

The most recent guidelines for the treatment of acute asthma exacerbation in children, including those from the American Academy of Pediatrics, emphasize weight-based dosing of rescue albuterol for optimal symptom relief. The objective of this study is to assess the adherence of emergency medical providers who care for children in a tertiary pediatric emergency department to these guidelines. We also assess whether level of training or primary training background affects adherence to these guidelines.

COMPARISON BETWEEN INHALATION AND SYSTEMIC STEROID THERAPY IN ACUTE EXACERBATION OF MODERATE TO SEVERE BRONCHIAL ASTHMA IN CHILDREN

Background: Corticosteroids are by far the most effective controllers used in the treatment of asthma and the only drugs that can effectively suppress the characteristic inflammation in asthmatic airways. They play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED. Objectives: To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) for acute asthma exacerbation. Methods: This was a prospective study done on children with acute asthma exacerbation coming to the emergency room of Al-Sayed Galal university hospital for evaluation and treatment. The study was carried out from July 2018 to January 2019. Results: 60 children were evaluated; 34 cases (56.7%) were males while 26 cases (43.3%) were females with age ranging between 2 and 14 years. No significant statistical difference was found between inhaled corticosteroids and systemic corticosteroids in treatment of acute exacerbation of moderate to severe bronchial asthma in children. Conclusion: There is no evidence of a difference between ICS and SC in terms of hospital admission rate, return to hospital within week, length of stay in ED and adverse effects in children consulting for asthma exacerbations.

Are Inhaled Corticosteroids and Inhaled Corticosteroids/Long-acting β-Agonist of Use in Acute Asthma: an Update on Evidence

Treatment of acute asthma exacerbations involves using systemic corticosteroids and short-acting β2-agonists (SABA). In an effort to limit the burden of systemic steroids, recent studies suggest benefit with the use of inhaled corticosteroids in an acute asthma exacerbation. Recent data has demonstrated benefit from the addition of inhaled corticosteroids to systemic steroids, increasing inhaled corticosteroid dose, and adding a separate inhaled corticosteroid inhaler during an exacerbation. Additionally, inhaled corticosteroid and fast-acting long-acting β-agonist (LABA) can be helpful when used in place of a SABA as a reliever of acute symptoms. This review summarizes recent data that demonstrates potential uses of inhaled corticosteroids and inhaled corticosteroids/LABA for the treatment of acute asthma. Further studies are necessary to evaluate the role of inhaled corticosteroids alone and in combination with SABA and LABA across all asthma severities.

Does the addition of azithromycin improve outcomes in the treatment of acute asthma exacerbations?

Does the addition of azithromycin improve outcomes in the treatment of acute asthma exacerbations?

Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol.

Evidence supports using dexamethasone for mild-to-moderate asthma exacerbations in the emergency department, but the effectiveness of dexamethasone versus prednisone for asthmatic patients who are hospitalized is unclear. Our aim was to compare outcomes for inpatients before and after our emergency department's adoption of dexamethasone for the treatment of acute asthma exacerbations. In this single-center retrospective cohort study, we employed interrupted time series analyses to control for secular trends while evaluating our outcomes of length of stay, total inflation-adjusted hospital charges, and ICU transfer rates for patients admitted with asthma. Data were analyzed over 36 months (January 2014-April 2017) and included 1015 subjects (606 in the preprotocol change [pre-PC] group and 409 in the postprotocol change [post-PC] group). In the pre-PC group, prednisone only was used in 96% of subjects. In the post-PC group, prednisone only was used in 7% of subjects, dexamethasone in 65% of subjects, and a combination of the 2 steroids in 28% of subjects. Controlling for other variables in the interrupted time series model, we found no significant immediate differences between the pre-PC and post-PC periods for the outcomes of length of stay (P = .68), total charges (P = .66), and ICU transfers (P = .98). The rate of ICU transfers was stable pre-PC and increased by 10% (95% confidence interval: 2%-19%) per month (odds ratio = 1.10; 95% confidence interval: 1.02-1.19; P = .02) in the post-PC period. After dexamethasone replaced prednisone as the most commonly prescribed steroid type for inpatients with asthma at our institution, we found no immediate changes in outcomes for asthmatic patients who were hospitalized but an upward trend in ICU transfers.

Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial

N Navanandan, M Federico, RD Mistry. J Pediatr. 2017;185:142–154.e2 To evaluate the effectiveness of positive expiratory pressure (PEP) in children presenting to the emergency department (ED) with moderate-to-severe asthma exacerbations. The study included children, 2 to 18 years old, who presented to a tertiary-care children’s hospital ED for an acute asthma exacerbation. This was a single-blinded, randomized study …

Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic.

Asthma, a chronic childhood disease, has resulted in increased emergency department (ED) visits with high costs. Many asthma ED visits are nonemergent and could be treated in outpatient clinics. Literature has concluded that a 2-day course of oral dexamethasone has comparable outcomes to a 5-day course of prednisone in the ED and hospital setting. A retrospective chart review was performed on children requiring in-house treatment with a corticosteroid (dexamethasone n = 23, prednisone n = 40) for acute asthma exacerbations at an ambulatory medical home. The rates of hospital admissions, ED visits, and symptom follow-up were similar between the 2 groups ( P > .05). The cost for a course of dexamethasone was US$1.28 versus US$16.20 for prednisolone. The average cost for an asthma exacerbation office visit was US$79.89 compared with US$3113.28 for an ED visit. A 2-day course of oral dexamethasone appears to be a promising clinical and cost-effective treatment for acute asthma exacerbations at the primary care level.

Are bronchodilator nebulizers superior to MDIs for the treatment of acute asthma exacerbations?

Are bronchodilator nebulizers superior to MDIs for the treatment of acute asthma exacerbations?

Montelukast Treatment of Acute Asthma Exacerbations in Children Aged 2 to 5 Years: A Randomized, Double-Blind, Placebo-Controlled Trial.

Although montelukast has an established role in the management of chronic asthma in children, its efficacy in acute asthma exacerbations (AAEs) in children aged 2 to 5 years is not fully known. This study aimed to evaluate the effectiveness and safety of montelukast for treating AAE in children aged 2 to 5 years in China. In total, 120 Chinese children with AAE, aged 2 to 5 years, were randomly divided into 2 groups, each with 60 patients. All patients received either montelukast or placebo along with standard therapy for acute asthma between January 2011 and December 2015. The outcome measurements included the difference in peak expiratory flow and lung function improvements, as well as adverse events. A total of 117 patients completed the study. Montelukast showed no greater effectiveness than did placebo in increasing the peak expiratory flow during the period of hospital stay (P = 0.92 at day 2, P = 0.86 at day 3, and P = 0.82 at day 4) and at discharge (P = 0.84). Similarly, the forced expiratory volume in 1 second at discharge also did not show significant difference between the 2 groups (P = 0.80). In addition, no serious adverse events were found during the intervention period of the study. The results of this study demonstrate no benefit of montelukast over placebo in the treatment of AAE in a cohort of 2- to 5-year-old children.

Dexamethasone Compared to Prednisone for the Treatment of Children With Acute Asthma Exacerbations.

Systemic corticosteroids are recommended in clinical practice guidelines for the treatment of acute asthma exacerbation based on evidence demonstrating reduced hospitalizations and improved outcomes after administration in the emergency department. Although prednisone and related oral preparations have been recommended previously, researchers have assessed dexamethasone as an alternative based on its longer biologic half-life and improved palatability. Systematic reviews of multiple small trials and 2 larger trials have found no difference in revisits to the emergency department compared to prednisone for dexamethasone given either as an intramuscular injection or orally. Studies of oral administration have found reduced emesis for dexamethasone compared to prednisone both in the emergency department and for a second oral dose, typically given 24 to 48 hours later. Studies assessing a single dose of dexamethasone have found equivalent improvement at follow-up but with some evidence of increased symptoms and increased need for additional corticosteroids compared to multiple doses of prednisone. Future research could further assess dexamethasone dose, formulation, and frequency and measure other related adverse effects such as behavior change. Consideration of baseline differences within the heterogeneous population of children requiring acute care for asthma may also guide the design of an optimal dexamethasone regimen.

Asthma treatment and outcomes for children in the emergency department and hospital

ABSTRACTObjective: To describe and compare the treatment of acute asthma exacerbations in children given in the emergency department (ED) and admitted to acute care floor in the hospital or intensive care unit (ICU). Methods: A retrospective chart review of visits for acute exacerbation of asthma treated at Phoenix Children's Hospital between January 1, 2014 and December 31, 2016. Results: A total of 287 asthma exacerbation cases were identified including 106 (37%) ED visits, 134 (47%) hospital floor and 47 (16%) ICU admissions. A history of a previous ED visit (ED 88%, Floor 60% and ICU 68%; p < 0.0001) and prior pulmonology inpatient consultation (ED 30%, Floor 19% and ICU 15%; p = 0.05) varied significantly. Pulmonology inpatient consultations were performed more frequently in the ICU than on the hospital floor (54% versus 8%; p < 0.0001). Although overall 145 (51%) of the cases were already on inhaled corticosteroids (ICS) at the time of visit with no differences across locations, ICS initiation/step-up was greater in the ICU (72%) than on the hospital floor (54%) and ED (2%) (p < 0.0001). A recommendation given to the family for follow-up with pulmonology was more frequent for patients who had been admitted to the ICU (68%) as compared to those only admitted to the floor (31%) or ED (4%) (p < 0.0001). Readmission rates were similar for patients previously admitted to the hospital (Floor 42%; ICU 40%), but significantly higher for previous ED visits (77%) (p < 0.0001). Conclusions: Physicians in the ED have an opportunity to provide preventative care in the acute care setting and should be encouraged to initiate treatment with ICS. Consideration should be given to develop a program or clinical pathway focused on long-term asthma management and maintenance to reduce readmissions and long hospital stays.

Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial

To evaluate the efficacy of brief, single administration of positive expiratory pressure (PEP) therapy in reducing clinical severity and need for additional second-line therapies and hospitalization in children presenting to the emergency department (ED) with acute asthma. This was a prospective randomized controlled trial of children 2-18 years of age presenting to a tertiary-care academic pediatric ED with moderate-to-severe asthma exacerbations from December 2014 to June 2016. Children who continued to have moderate asthma severity after completion of initial therapies (albuterol/ipratropium bromide and corticosteroids) were randomized to receive PEP therapy or standard of care. The primary outcome was change in pulmonary asthma score before and after intervention, as assessed by a blinded physician. Secondary outcomes included need for additional therapies, ED length of stay, and disposition. A total of 52 patients were randomized to receive either PEP (n?=?26) or standard therapy (n?=?26). Study groups were similar in demographics and baseline characteristics. There was no significant difference in primary outcome between groups with a mean change in Pulmonary Asthma Score of 0.92 (±1.2) in the PEP group and 0.40 (±1.2) in the standard group (P?=?.12). There also was no significant difference in need for additional therapies, ED length of stay, and disposition. Mild, self-resolving side effects were observed in 3 subjects receiving PEP therapy. Single, brief, administration of PEP therapy after completion of first-line therapies does not improve clinical severity in children presenting to the ED with acute asthma. ClinicalTrials.gov: NCT02494076.

P117 The extent of immunosuppression from systemic steroid bursts in inner-city asthmatic children - an update

Systemic corticosteroids are mainstay treatment for acute asthma exacerbations. The effect of chronic administration of systemic steroids in patients with autoimmune disorders has been reported. However, the quantified severity and extent of immunosuppression in asthmatic children receiving frequent systemic steroids bursts has not been reported.

The Impact of Standardizing Assessment and Treatment of Acute Asthma Exacerbations on Emergency Department Efficiency

The Impact of Standardizing Assessment and Treatment of Acute Asthma Exacerbations on Emergency Department Efficiency

Update on the utility of corticosteroids in acute pediatric respiratory disorders.

Corticosteroids, delivered systemically and by inhalation, are widely used for the treatment of multiple acute respiratory illnesses in children. However, the level of evidence to support the utility of this therapy varies between these different acute respiratory illnesses. To summarize the evidence regarding the utility of corticosteroids in the management of common acute pediatric respiratory conditions and to highlights the controversies regarding their use. Literature search of manuscripts describing the evidence regarding the efficacy of corticosteroids (systemic and inhaled) in the management of: acute asthma exacerbation among school age children, acute episodic wheeze among preschool children, viral croup, and acute viral bronchiolitis. Current evidence indicates that systemic corticosteroids provide benefits for the treatment of acute asthma exacerbations in school age children, mainly in the acute care setting. In addition, high dose inhaled corticosteroid therapy administered in the Emergency Department appears to have comparable effect for the prevention of asthma-related hospital admission as systemic corticosteroids in this age group. In contrast, most available studies have not shown benefit for systemic corticosteroids during acute wheezing episodes in preschool children. Systemic corticosteroids decrease symptoms and the rate of hospital admissions in patients with severe croup; however, corticosteroids have no role in the treatment of acute bronchiolitis and their use in this condition should be discouraged. Corticosteroids treatment response varies between the acute respiratory illnesses presented in this review. Future research should aim to fill the current gaps-of-knowledge regarding the utility this intervention such as the identification of specific wheezing phenotypes among preschool children which might benefit from systemic corticosteroids as a treatment for acute viral wheeze.

Managing acute asthma in school age children

Acute asthma exacerbations (AAEs) can be life-threatening, accelerate the decline in lung function and may increase the risk of further attacks. Inhaled short-acting ß2 agonists are the first-line treatment for AAEs in school-aged children. The school policy should describe how to use rescue bronchodilators with a spacer and when to call 999. School nurses should ensure that headteachers are aware that schools can now buy salbutamol inhalers for emergency use. AAEs often indicate suboptimal care. According to Asthma UK, just 28% of children meet all three markers of good quality care: a written action plan, checks of inhaler technique and a structured review at least annually. An AAE offers school nurses the opportunity to encourage a review of the child's treatment and other elements of care, which helps reduce the risk of another attack.

Clinical outcomes after bilevel positive airway pressure treatment for acute asthma exacerbations.

Clinical outcomes after bilevel positive airway pressure treatment for acute asthma exacerbations.

Dexamethasone for acute asthma exacerbations in children: a meta-analysis.

BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions. METHODS: A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. Data were abstracted by 4 authors and verified by a second author. Two reviewers evaluated study quality independently and interrater agreement was assessed. RESULTS: There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46–1.78, Q = 1.86, df = 3, I2 = 0.0%, 10–14 days RR 1.14, 95% CI 0.77–1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03–56.93). Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12–0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14–0.74, Q = 2.09, df = 2, I2 = 4.2%). CONCLUSIONS: Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone.

PS-385a Clinical Outcomes After Bilevel Positive Airway Pressure (bipap) Treatment For Acute Asthma Exacerbations: Abstract PS-385a Table 1

Aims To examine whether bilevel positive airway pressure (BiPAP) for children with acute asthma exacerbations not approaching respiratory failure (not meeting NIH and GINA guidelines for noninvasive ventilation) is associated with improved clinical outcomes. Methods We prospectively enrolled children 5–17 years with exacerbations not meeting respiratory failure guidelines for BiPAP use in a paediatric emergency department. We modelled propensity scores for BiPAP treatment then used propensity score matching to estimate the associations of BiPAP treatment with hospital admission; PICU admission; hospital length-of-stay; and time to Q4 hr albuterol as a metric of clinical improvement. Results Amongst 933 participants, median [IQR] age was 8.8[6.9,11.2] years, male 61%, and African-American 59%. BiPAP-treated participants (n = 45) had similar demographic characteristics to BiPAP-untreated participants in the matched analysis and significantly greater likelihood of hospital and PICU admission (Table ). Conclusions BiPAP treatment for paediatric patients with asthma exacerbations not meeting respiratory failure guidelines may be associated with greater resource utilisation without evidence of improved outcomes.