Approach of asthma exacerbation in pediatrics

Abstract

Introduction: exacerbation of asthma is a common cause of search for emergency care units and hospitalization. Its resolution requires early recognition and appropriate treatment. Objective: this non-systematic review of scientific literature aims to present updated in­formation on acute asthma care in pediatrics. Data sources: databases Medline, Lilacs and SciELO. The terms ‘asthma’, ‘acute asthma’, ‘asthma exacerbation’, ‘children’ and ‘treat­ment’ were investigated. Guidelines or consensus published from 2007 to 2017 and more recent articles on acute asthma therapy in pediatrics were selected. Data synthesis: every patient should have a plan of action prescribed by the physician. In the emergency, the approach is based on severity of the exacerbation. Salbutamol inhalation, oxygen the­rapy (in case of hypoxemia) and systemic corticosteroids are the main initial therapeutic measures. Alternative drugs include inhaled ipratropium bromide and magnesium sulfate. Patients in the emergency room should be closely monitored and reassessed at short inter­vals, aiming for timely hospitalization in an intensive care unit if necessary. Conclusions: the approach of asthma in the emergency department requires ready diagnosis, assessment of severity and prompt treatment. It is a priority to identify patients at risk of death, and who are worsening or not responding to emergency treatment. They should be transfer­red to intensive care units as soon as possible. Discharge should be given when patient is stable, accompanied by prescription for the next few days and with an outpatient review consultation scheduled.