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Management of acute, severe asthma in children
Darcie D Streetman1, Varsha Bhatt-Mehta, Cary E Johnson
1Pediatrics, University of Michigan Health-Systems, Ann Arbor 48109-0008, USA. darcieds@umich.edu
Insights
Current treatments for severe pediatric asthma include albuterol, ipratropium, and corticosteroids. While effective, research continues for better options due to safety and efficacy questions with alternatives.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Pharmacology
Background:
- Acute asthma exacerbations in children present significant management challenges.
- Standard therapies are effective but not universally optimal.
Purpose of the Study:
- To review current emergency and inpatient treatments for acute, severe asthma in children.
- To explore emerging therapies for future pediatric asthma management.
Main Methods:
- Comprehensive MEDLINE literature search (1966-May 2001) for acute asthma drug therapy.
- Inclusion of pediatric and relevant adult studies, guidelines.
Main Results:
- Albuterol, ipratropium, and systemic corticosteroids are established effective treatments.
- Older agents like magnesium and theophylline are under reevaluation; their benefits over maximal beta(2)-agonist therapy are unclear.
- Limited pediatric data exist for magnesium; newer therapies like heliox and leukotriene modifiers require further evaluation.
Conclusions:
- Beta(2)-agonists, ipratropium, and corticosteroids are primary agents for pediatric acute asthma.
- There is an ongoing need for safer and more effective treatment options for pediatric asthma exacerbations.
Objective:
To briefly present the current options available for the treatment of acute, severe asthma in children, with a special focus on emergency department and inpatient treatment, and to describe newer therapies that may aid treatment in the future.
Data Sources And Study Selection:
A MEDLINE search (1966-May 2001) of the English-language literature pertaining to drug therapy of acute asthma was performed. Key word searches included acute asthma, albuterol, ipratropium, corticosteroids, magnesium, and theophylline. Additional articles from these sources and published national guidelines were identified. Relevant studies pertaining to current therapy of acute asthma in pediatric patients were selected; if there were minimal pediatric data, adult data were included.
Data Synthesis:
Asthma is a chronic, inflammatory disorder of the airways. Acute exacerbations can occur and are challenging to manage. Albuterol, ipratropium, and systemic corticosteroids have been shown to be effective in acute asthma exacerbations. Because some patients do not respond to maximal therapy, older therapies such as magnesium and theophylline are being reevaluated. Theophylline may have some therapeutic effect, but given its toxicity profile, it is unclear whether it offers any advantage over maximal beta(2)-agonist therapy. There are only minimal published data evaluating the use of magnesium in pediatrics, and most are small trials or case reports. Newer therapies such as ventilation strategies with heliox and intravenous leukotriene modifiers currently being evaluated may or may not prove to be beneficial in the future.
Conclusions:
beta(2)-agonists, ipratropium, and corticosteroids remain the most useful therapeutic agents for acute asthma exacerbations in pediatric patients. However, these agents are not ideal in all patients and, given the existing questions regarding safety and/or efficacy of available alternatives, more effective options are needed.