RT Book, Section
A1 O’Sullivan, Ronan
A1 McLoughlin, Darren
A2 Tenenbein, Milton
A2 Macias, Charles G.
A2 Sharieff, Ghazala Q.
A2 Yamamoto, Loren G.
A2 Schafermeyer, Robert
SR Print(0)
ID 1155296567
T1 Asthma
T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 5e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9781259860751
LK accesspediatrics.mhmedical.com/content.aspx?aid=1155296567
RD 2024/04/19
AB 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.