Acute asthma exacerbation in children

Acute asthma exacerbations in children present 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 exacerbations require oxygen, nebulised/intravenous bronchodilators, and intravenous corticosteroids and may require magnesium sulfate infusion, intravenous bronchodilators, and intramuscular adrenaline (if anaphylaxis is present).

Severe and life-threatening exacerbations 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 treatment for asthma, other differential diagnoses should be considered.

On discharge from hospital, a clear asthma management plan and asthma education are essential to optimise asthma control and prevent future exacerbations.

An asthma exacerbation is an acute or sub-acute episode of airflow obstruction occurring on a background of chronic airway inflammation and airway hyper-responsiveness. The exacerbation is initiated by a trigger that produces bronchoconstriction and increased mucus production, thereby worsening asthma symptoms such as wheeze, cough, dyspnoea, and respiratory distress. This topic covers the treatment of children up to 11 years of age. Children 12 years and older are treated the same as adults, except that the authors of this paediatric topic do not recommend high-dose inhaled corticosteroids in the emergency department as an adjunct in children aged 12 to 18 years, because oral corticosteroids are more effective in this setting. Please see our Acute asthma exacerbation in adults topic for more information.