Summary

• Despite the stabilisation of asthma incidence in recent years, asthma exacerbations remain a major cause of morbidity in children.
• Presents with acute or sub-acute onset of wheeze and respiratory distress, the symptoms and signs of which vary depending on the developmental and maturational age of the child.
• Triggers include viral or bacterial infection, inhaled allergens, environmental irritants, emotion, medications, and poor adherence with preventive therapy.
• The majority of children will respond to initial bronchodilator therapy; oral corticosteroids should be initiated early in those who do not respond to regular bronchodilator therapy.
• Patients with severe cases require oxygen, nebulised/intravenous bronchodilators, and intravenous corticosteroids and may require magnesium sulphate infusion, intravenous bronchodilators, and intramuscular adrenaline (if anaphylaxis is present).
• Severe and life-threatening cases may require non-invasive ventilation or intubation, and the intensive care team should be involved as early as possible.
• In children not responding to standard asthmatic treatment, other differential diagnoses should be considered.
• On discharge from hospital, a clear asthma management plan and asthma education is essential to optimise asthma control and prevent future exacerbations.