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[Acute severe asthma in children. Epidemiological, physiopathological and clinical aspects]
M Fayon1, T Lamireau, J Sarlangue
1Service des soins intensifs pédiatriques, hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
Insights
Even mild asthma can be fatal in children due to various physiological factors. Identifying children at risk is crucial for optimizing asthma management and preventing severe outcomes.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Asthma therapy is increasingly common, yet asthma mortality rates remain high globally.
- Fatal asthma attacks are not exclusively linked to inadequate medical follow-up.
- Children with mild to moderate asthma symptoms can experience life-threatening exacerbations.
Purpose of the Study:
- To investigate the factors contributing to fatal asthma attacks in children.
- To highlight the potential for severe outcomes even in non-severe asthma cases.
- To emphasize the importance of identifying at-risk children for optimized asthma care.
Main Methods:
- Review of clinical factors associated with fatal asthma outcomes.
- Analysis of physiological mechanisms implicated in severe asthma exacerbations.
- Examination of altered chemosensitivity and dyspnea perception in near-fatal asthma cases.
Main Results:
- Fatal asthma can result from asphyxia (ventilation/perfusion mismatch, bronchospasm), cardiac failure, arrhythmia, intrinsic positive expiratory pressure, or metabolic disturbances like hypokalemia.
- Altered chemosensitivity to hypoxia and dyspnea perception are observed in patients with near-fatal asthma.
- These complications can occur in predisposed children, irrespective of initial symptom severity.
Conclusions:
- Children with mild to moderate asthma are susceptible to fatal attacks.
- Identifying children at risk of severe asthma is paramount.
- Optimizing care strategies for at-risk children is essential for reducing asthma mortality.
Abstract:
Therapy for asthma is being prescribed more frequently. However, asthma mortality remains high in many countries. Fatal outcome is not always related to inadequate follow-up. In this article we report that children with mild to moderate symptoms may present a fatal attack. Many factors are responsible for such an outcome: asphyxia +3 due to ventilation/perfusion mismatch and/or bronchospasm, cardiac failure, cardiac arrhythmia, intrinsic positive expiratory pressure, or metabolic disturbances (hypokalemia, for example). Such problems can occur in predisposed patients: it has been shown that the chemosensitivity to hypoxia and the perception of dyspnoea are altered in certain patients with near-fatal asthma. It is very important to identify children at risk of severe asthma and to organize care so as to optimize the management of such children.