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[Acute asthmatic crisis in children]
J C Dubus1, A C Bodiou, C Buttin
1Service de médecine infantile, CHU Timone-Enfants, Marseille, France.
Insights
Acute asthma attacks in children require rapid assessment and urgent treatment with inhaled bronchodilators and systemic steroids. Prompt hospitalization and follow-up care, including inhaled corticosteroids, are crucial for recovery and prevention.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
Context:
- Acute asthma attacks in children present as life-threatening respiratory distress.
- These attacks may show limited response to standard bronchodilator therapy.
- Rapid evaluation of episode severity is critical.
Purpose:
- To outline the urgent management strategies for acute asthma exacerbations in pediatric patients.
- To emphasize the importance of recognizing clinical signs of severity.
- To detail the stepwise treatment approach for severe pediatric asthma.
Summary:
- Initial treatment involves high-dose inhaled short-acting beta 2-agonists, with anticholinergic drugs added for severe obstruction.
- Systemic steroids should be prescribed early due to their delayed onset.
- Hospitalization, oxygen, hydration, and continuous nebulization or IV beta 2-agonists with monitoring are indicated for persistent symptoms.
- Pediatric intensive care unit admission may be necessary for refractory cases, potentially requiring mechanical ventilation.
Impact:
- Effective management reduces morbidity and mortality associated with severe pediatric asthma attacks.
- Early intervention and appropriate follow-up care, including inhaled corticosteroid prophylaxis, improve long-term outcomes.
- Patient and family education is essential for preventing future exacerbations and ensuring adherence to treatment plans.
Abstract:
Acute asthma attack in children is an attack responsible for life-threatening acute respiratory distress with partial or no response to bronchodilator drugs. The severity of the episode needs to be quickly evaluated. This presupposes a perfect knowledge of the clinical signs of severity. Treatment is urgent and first based on the administration of high doses of inhaled short-acting beta 2-agonists. In the more obstructed children, anti-cholinergic drugs can be added to nebulized beta 2-agonists. Because of their delayed effect, systemic steroids require an early prescription. Symptomatic treatments are: urgent hospitalization, oxygen if needed, proper hydratation. Continuous nebulization or intravenous perfusion of beta 2-agonists are prescribed with cardiac monitoring when no objective improvement is noted. Admission into the pediatric intensive care unit when bronchial obstruction continues will permit the association of bronchodilator drugs and the proposal of mechanical ventilation if needed. When the episode is resolved, a prophylactic treatment using inhaled corticosteroids must be prescribed. Clinical and spirometric follow-up has to be organized, and the patient and his/her family have to be educated.