Acute asthma exacerbation in children

Asthma exacerbations 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 cases 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 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.

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.