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Approaches to acute asthma and status asthmaticus in children
D R Nelson1, M I Sachs, E J O'Connell
1Department of Pediatrics, Mayo Clinic, Rochester, MN 55905.
Insights
Pediatric asthma, a common chronic disease, involves airway inflammation causing obstruction. Effective maintenance programs are key to preventing acute asthma attacks and status asthmaticus in children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Asthma is the most frequent chronic illness in children, representing a significant cause of childhood disability.
- The primary drivers of asthma's functional abnormalities, airway obstruction, and hyperresponsiveness are airway inflammation.
- Current therapeutic strategies for acute asthma and status asthmaticus focus on mitigating airway inflammation.
Purpose of the Study:
- To outline the management of acute asthma and status asthmaticus in pediatric patients.
- To discuss the prevention of acute asthma exacerbations and status asthmaticus.
Main Methods:
- Inhaled beta-adrenergic medications are used in outpatient and emergency settings to reverse airway obstruction.
- Intravenous aminophylline, corticosteroids, nebulized beta-adrenergic agents, and oxygen are administered for status asthmaticus.
- Continuous nebulization of albuterol is employed to treat respiratory failure, with mechanical ventilation reserved for refractory cases.
Main Results:
- Inhaled beta-adrenergic agents effectively reverse airway obstruction in acute asthma.
- Pharmacologic interventions, including continuous albuterol nebulization, can manage respiratory failure in status asthmaticus.
- Mechanical ventilation is a last resort for patients unresponsive to medical treatment.
Conclusions:
- Effective management of acute asthma and status asthmaticus relies on addressing airway inflammation and obstruction.
- Individualized maintenance programs are crucial for preventing asthma exacerbations and status asthmaticus in pediatric patients.
Abstract:
Asthma is the most common chronic disease in pediatric patients and is the leading cause of childhood disability. The functional abnormalities of this disease--namely, airway obstruction and hyperresponsiveness--are consequences primarily of airway inflammation. Outpatient therapy for acute asthma, as well as therapy for status asthmaticus (episodes of asthma unresponsive to usually effective outpatient therapy and necessitating hospitalization), primarily addresses treatment of airway inflammation. The goal of office and emergency room management of acute asthma is reversal of airway obstruction by the administration of inhaled beta-adrenergic medications. The therapy for status asthmaticus consists of intravenously administered aminophylline, corticosteroids, nebulized beta-adrenergic agents, and oxygen. Respiratory failure, the inability to maintain adequate elimination of CO2, may be effectively treated by adding continuous nebulization of albuterol. Mechanical ventilation will still be necessary in the rare patient who does not respond to pharmacologic therapy. Acute exacerbations of asthma, as well as status asthmaticus, can best be prevented by establishing effective maintenance programs individualized for each patient.