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Management of Acute Severe Asthma (Status Asthmaticus)

Anil Tambe , Anil Tambe , Milind S Tullu

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Indian Journal of Trauma and Emergency Pediatrics 4(2):p 63-73, April - June 2012. | DOI:

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Abstract

Asthma is a chronic disease of the respiratory tract characterized by recurrent episodes of airway nflammation and obstruction, showing evidence of reversibility of obstruction. Despite advances in the understanding of asthma and development of effective medical interventions for treatment of asthma (and for prevention of morbidity), children continue to present to the emergency departments of health care institutions with acute asthma exacerbations. An accurate assessment of the severity of the acute attack is essential to ensure optimal treatment. Asthma exacerbations are defined as ‘acute or sub-acute episodes of progressively worsening shortness of breath, cough, wheezing, and chest tightness – or some combination of these symptoms.’ The pathophysiology of an asthma exacerbation includes airway edema, mucus secretion and smooth-muscle spasm (bronchospasm). The foundations of the treatment of acute asthma are bronchodilators, corticosteroids and oxygen. Before the initiation of therapy, and as therapy is initiated, a brief, focused history and physical examination should be obtained. Escalation of the therapy (aminophylline, magnesium sulfate, rarely mechanical ventilation, etc) may be necessary in severe exacerbations. This review details the assessment and treatment of acute episode of asthma in children.

Keywords: Aminophylline; Asthma; Beta-2- agonists; Children; Hyperinflation; Pulmonary; Ronchi; Salbutamol; Steroids; Terbutaline.

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