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Updated: Jun 7, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Lung Ultrasound Findings in Children With Asthma Exacerbations
Robert M Hoffmann1,2, Mark I Neuman1,2, Michelle Du1,2
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Lung ultrasound (LUS) findings, particularly B-lines, are common in pediatric asthma exacerbations and correlate with severity. Other LUS findings like consolidations were not associated with asthma severity in children.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Medical Imaging
Background:
- Asthma exacerbations are a common reason for pediatric emergency department visits.
- Accurate assessment of asthma exacerbation severity is crucial for appropriate management.
- Lung ultrasound (LUS) is a non-invasive imaging modality with potential applications in respiratory conditions.
Purpose of the Study:
- To evaluate the association between the presence and extent of lung ultrasound (LUS) findings and the severity of asthma exacerbations in children.
- To determine which specific LUS findings correlate with different levels of asthma severity.
Main Methods:
- A convenience sample of 111 children (aged 5-18 years) with acute asthma exacerbation was enrolled.
- Asthma exacerbation severity was classified as mild, moderate, or severe using the Hospital Asthma Severity Score within one hour of LUS.
- Trained pediatric emergency providers performed LUS, assessing for B-lines, consolidations, pleural effusion, and pleural line abnormalities based on consensus guidelines.
Main Results:
- 57% of enrolled patients had positive LUS findings.
- B-lines were significantly more prevalent in moderate (31%) and severe (43%) asthma exacerbations compared to mild (12%) exacerbations (P=.021).
- The presence of lung consolidations (<1cm or ≥1cm) and other LUS findings did not correlate with asthma severity.
Conclusions:
- Lung ultrasound findings are frequently observed in children with asthma exacerbations.
- B-lines on LUS are associated with increased asthma exacerbation severity in pediatric patients.
- LUS, particularly the presence of B-lines, may aid in the diagnostic assessment of asthma severity in children.
Objective:
We sought to assess whether the presence and extent of lung ultrasound (LUS) findings were associated with asthma exacerbation severity in children.
Methods:
We enrolled a convenience sample of patients aged 5-18 years presenting with acute asthma exacerbation to a tertiary care pediatric emergency department. Severity of an asthma exacerbation (mild, moderate, severe) was assessed within 1 hour of the LUS using the Hospital Asthma Severity Score, a validated asthma assessment tool. LUS was performed by trained pediatric emergency providers. The presence of LUS findings (B-lines, consolidations, pleural effusion, and pleural line abnormalities) was assessed using a standardized criterion based on consensus guidelines.
Results:
A total of 111 patients with a median age of 8 years (interquartile range 6-12) were enrolled. LUS was positive in 57% of patients. Pleural line abnormalities were observed in 34%, B-lines in 29%, consolidations <1 cm in 24%, and consolidations ≥1 cm in 7%. Patients with moderate and severe asthma exacerbations were more likely to have any B-lines (31% and 43%, respectively) than patients with mild exacerbations (12%; P = .021); however, the presence of ≥3 B-lines or confluent B-lines did not differ across severity groups. The presence of other findings did not differ based on asthma severity.
Conclusions:
LUS findings are observed in a substantial portion of children presenting with asthma exacerbations. B-lines were the only LUS finding significantly associated with asthma severity, while lung consolidations <1 cm and >1 cm were not correlated with severity. These findings provide valuable information for the diagnostic use of LUS in pediatric patients with asthma exacerbation.
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