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Pediatric acute asthma exacerbations: Evaluation and management from emergency department to intensive care unit
Brittany Pardue Jones1, Geoffrey M Fleming2, Jaime Kaye Otillio1
1a Department of Pediatrics , Division of Emergency Medicine.
Insights
This review covers pediatric asthma exacerbation management, including standard and advanced treatments beyond current guidelines. It emphasizes a continuum of care from the emergency room to the intensive care unit for better outcomes.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Critical Care
Background:
- Asthma is the most common chronic childhood disease, with exacerbations posing a significant public health burden.
- Effective management of acute asthma exacerbations is crucial for reducing morbidity and preventing mortality in children.
- Current guidelines provide a framework, but a broader understanding of available interventions is needed.
Purpose of the Study:
- To review current and emerging modalities for assessing and managing acute asthma exacerbations in pediatric patients.
- To include treatments not covered in existing expert panel guidelines, such as the National Asthma Education and Prevention Program (NAEPP).
- To emphasize the continuum of care for pediatric asthma exacerbations between the emergency room (ER) and intensive care unit (ICU).
Main Methods:
- Conducted a PubMed search using comprehensive terms related to pediatric asthma exacerbations, epidemiology, pathophysiology, and various treatment modalities.
- Evaluated evidence based on a hierarchy: meta-analyses of randomized controlled trials (RCTs) > individual RCTs > observational studies.
- Reviewed guidelines from the NAEPP and the Global Initiative for Asthma (GINA).
Main Results:
- Inhaled albuterol and systemic corticosteroids are primary treatments for pediatric asthma exacerbations.
- Escalation of care may involve additional interventions reviewed in this report.
- The review encompasses a wide range of treatments, from standard to advanced, for comprehensive management.
Conclusions:
- Optimal assessment and management, including escalation of interventions, are vital for pediatric asthma exacerbation care.
- This review provides a broader perspective on available treatments to support clinical decision-making.
- Ensuring a seamless transition of care between different healthcare settings is essential for pediatric asthma patients.
Objective:
The goal of this report is to review available modalities for assessing and managing acute asthma exacerbations in pediatric patients, including some that are not included in current expert panel guidelines. While it is not our purpose to provide a comprehensive review of the National Asthma Education and Prevention Program (NAEPP) guidelines, we review NAEPP-recommended treatments to provide the full range of treatments available for managing exacerbations with an emphasis on the continuum of care between the ER and ICU.
Data Sources:
We searched PubMed using the following search terms in different combinations: asthma, children, pediatric, exacerbation, epidemiology, pathophysiology, guidelines, treatment, management, oxygen, albuterol, β2-agonist, anticholinergic, theophylline, corticosteroid, magnesium, heliox, BiPAP, ventilation, mechanical ventilation, non-invasive mechanical ventilation and respiratory failure. We attempted to weigh the evidence using the hierarchy in which meta-analyses of randomized controlled trials (RCTs) provide the strongest evidence, followed by individual RCTs, followed by observational studies. We also reviewed the NAEPP and Global Initiative for Asthma expert panel guidelines.
Results And Conclusions:
Asthma is the most common chronic disease of childhood, and acute exacerbations are a significant burden to patients and to public health. Optimal assessment and management of exacerbations, including appropriate escalation of interventions, are essential to minimize morbidity and prevent mortality. While inhaled albuterol and systemic corticosteroids are the mainstay of exacerbation management, escalation may include interventions discussed in this review.
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