Asthma exacerbations present with acute or subacute 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, nebulized/intravenous bronchodilators, and intravenous corticosteroids and may require magnesium sulfate infusion, intravenous bronchodilators, and intramuscular epinephrine (if anaphylaxis is present).
Severe and life-threatening cases may require noninvasive 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 the hospital, a clear asthma management plan and asthma education is essential to optimize asthma control and prevent future exacerbations.
An asthma exacerbation is an acute or subacute episode of airflow obstruction occurring on a background of chronic airway inflammation and airway hyperresponsiveness. The exacerbation is initiated by a trigger that produces bronchoconstriction and increased mucus production, thereby worsening asthma symptoms such as wheeze, cough, dyspnea, and respiratory distress.
Department of Respiratory Medicine
Children's Hospital at Westmead
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
New South Wales
PDR declares that he has no competing interests.
Menzies School of Health Research
Charles Darwin University
Respiratory and Sleep Physician
Royal Children's Hospital
AC has received research funds from governmental bodies such as Australian National Health and Medical Research Council. AC is an author of a reference cited in this monograph.
Professor of Pediatrics
University of Chicago Comer Children's Hospital
LAL declares that she has no competing interests.
Consultant in Paediatrics
Adolescent Medicine & Paediatric Respiratory Medicine
University College London Hospitals NHS Foundation Trust
CM declares that he has no competing interests.
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