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HIGH-YIELD FACTS

  • Asthma is the most common chronic disease of childhood and is associated with significant morbidity and mortality.

  • It is defined as “a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyper responsiveness, and an underlying inflammation.”

  • Preschoolers with wheezing can be categorized into two patterns: “episodic viral” and “multiple trigger” (atopic) wheezing. These categories, though difficult to distinguish, can be helpful for guiding treatment over time.

  • Inhaled albuterol remains the first-line therapy for acute asthmatic exacerbations. Delivery of albuterol by metered dose inhaler and spacer device has been shown to be superior to delivery by nebulization.

  • The addition of ipratropium to the first two to three albuterol doses has been associated with a decreased need for hospitalization in children attending the emergency department (ED) with moderate-to-severe asthma exacerbations.

  • Early administration of oral corticosteroids in the ED has been shown to enhance recovery from an acute asthma exacerbation and decrease rates of hospitalization.

  • Oral dexamethasone (one or two doses) has been shown to be as effective as a 5-day course of oral prednisone.

  • Magnesium sulfate is of benefit in patients with moderate-to-severe exacerbations who do not respond to initial bronchodilator therapy, and should be the first-line parenteral bronchodilator.

  • Asthma education, including asthma action plans on ED discharge, provided to children and their parents while in the ED results in fewer future ED visits and hospital admissions.

Asthma is the most common chronic disease of childhood.1 The International Study of Asthma and Allergies in Childhood (ISAAC) has identified differences in the prevalence of asthma internationally, ranging from 1.6% in Indonesia to 36.7% in the United Kingdom.2 Prevalence of asthma in the United States is estimated at 8.4%, affecting an estimated 6.2 million children under 18 years of age.3 The overall prevalence is highest in developed countries and is highest in urban versus rural areas. Most children develop asthma under 5 years of age.

Acute exacerbations of asthma are often managed in emergency departments (EDs). The Centers for Disease Control (CDC) reported that in 2013 approximately 571,000 US children (<15 years old) were treated for an acute exacerbation of asthma in the ED.4

ETIOLOGY/PATHOPHYSIOLOGY

Asthma has been defined as intermittent, reversible obstructive airway disease and is a chronic inflammatory disorder of the airways with acute exacerbations. The most recent National Heart, Lung, and Blood Institute (NHLBI) expert panel guidelines (2007) define asthma as “a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyper responsiveness, and an underlying inflammation.” The interaction of these features determines the clinical manifestations, severity of asthma, and response to treatment.5

The major pathophysiology of asthma includes increased airway responsiveness, inflammation, mucus production, and submucosal edema. Airway responsiveness is defined as the ease with which airways narrow in response to various non-allergic stimuli. The level of airway responsiveness correlates with the ...

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