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Management of acute asthma exacerbations
Erin K Stenson1, Michael J Tchou, Derek S Wheeler
1aDivisions of Critical Care Medicine bHospital Medicine, Cincinnati Children's Hospital Medical Center cDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Insights
Current guidelines for pediatric acute asthma exacerbations focus on reversing bronchospasm and hypoxia. Quality improvement initiatives show promise in reducing costs and improving outcomes for childhood asthma management.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Critical Care
Background:
- Asthma is a leading chronic condition in children and a primary cause of hospital admissions.
- Acute asthma exacerbations represent a significant healthcare burden despite recent trends in prevalence.
- Evidence supporting specific pharmacologic agents for acute pediatric asthma is limited.
Purpose of the Study:
- To review current management guidelines for acute asthma exacerbations in children.
- To focus on emergency department, inpatient, and intensive care unit (ICU) settings.
- To highlight strategies for improving outcomes and reducing costs.
Main Methods:
- Review of current clinical practice guidelines.
- Analysis of recent epidemiological and healthcare expenditure data.
- Synthesis of quality improvement studies.
Main Results:
- Childhood asthma prevalence shows varied trends across demographic groups.
- Acute asthma exacerbations contribute substantially to healthcare costs.
- Quality improvement science has demonstrated potential for cost reduction and outcome enhancement.
Conclusions:
- Management principles include reversing bronchospasm, correcting hypoxia, and preventing relapse.
- Use of second- and third-tier agents is generally restricted to the ICU.
- Reducing treatment variability is crucial for lowering costs and improving pediatric asthma care outcomes.
Purpose Of Review:
Herein, we review the current guidelines for the management of children with an acute asthma exacerbation. We focus on management in the emergency department, inpatient, and ICU settings.
Recent Findings:
The most recent statistics show that the prevalence of asthma during childhood has decreased in certain demographic subgroups and plateaued in other subgroups. However, acute asthma accounts for significant healthcare expenditures. Although there are few, if any, newer therapeutic agents available for management of acute asthma exacerbations, several reports leveraging quality improvement science have shown significant reductions in costs of care as well as improvements in outcome.
Summary:
Asthma is one of the most common chronic conditions in children and the most common reason that children are admitted to the hospital. Nevertheless, the evidence to support specific agents in the management of acute asthma exacerbations is surprisingly limited. The management of acute exacerbations focuses on reversal of bronchospasm, correction of hypoxia, and prevention of relapse and recurrence. Second-tier and third-tier agents are infrequently used outside of the ICU setting. Reducing the variation in treatment is likely to lead to lower costs and better outcomes.
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