Paediatrics: how to manage acute asthma exacerbations

Area of Science:

• Pediatric Pulmonology
• Emergency Medicine
• Clinical Pharmacology

Background:

• Asthma is a leading chronic childhood illness, with acute asthma exacerbations (AAEs) posing significant health and economic burdens.
• AAEs in children are linked to emergency department visits, hospitalizations, and mortality.
• Effective treatment strategies for pediatric AAEs are crucial for mitigating these impacts.

Purpose of the Study:

• To review the evidence on the efficacy of medications used in managing pediatric acute asthma exacerbations (AAEs).
• To present this evidence within a stepwise management pathway for pediatric AAEs.
• To synthesize recommendations from international guidelines for a comprehensive care framework.

Main Methods:

• Conducted a narrative literature review.
• Focused on the efficacy of various pharmacological interventions for pediatric AAEs.
• Developed a management pathway integrating recommendations from eight established guidelines.

Main Results:

• Management of pediatric AAEs involves four key goals: severity assessment, prompt intervention, appropriate disposition, and safe discharge planning.
• Recommended medications include systemic corticosteroids, bronchodilators (salbutamol/albuterol, ipratropium bromide, magnesium sulfate), and second-line agents (aminophylline, IV salbutamol/terbutaline, epinephrine, ketamine).
• Clinical scoring, pathway-driven care, and discharge planning enhance AAE management.

Conclusions:

• Pediatric AAEs are primarily managed with evidence-based medications.
• Further research is needed on second-line bronchodilator efficacy.
• Integrating AAE management with long-term asthma control and ensuring equitable care are essential.