Acute asthma exacerbation in children

Last reviewed: 26 Apr 2022
Last updated: 19 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • wheezing
  • shortness of breath
  • tachypnoea
  • chest tightness
More key diagnostic factors

Other diagnostic factors

  • cough
  • exercise limitation
  • tachycardia
  • inability to speak or feed
  • intercostal, sub-costal, or sternal retraction
  • accessory muscle use
  • pulsus paradoxus
  • sleep disturbance
  • bradycardia
  • cyanosis
  • exhaustion
  • decreased consciousness level
Other diagnostic factors

Risk factors

  • viral infection
  • uncontrolled asthma symptoms
  • high use of short-acting beta-2 agonists
  • inadequate use of inhaled corticosteroids
  • incorrect inhaler technique
  • low forced expiratory volume in 1 second (FEV₁)
  • high bronchodilator reversibility
  • inhaled allergens
  • exercise
  • poor adherence with regular asthma medication
  • history of asthma
  • history of other atopic disease
  • family history of atopic disease
  • history of hospitalisation for asthma exacerbations
  • one or more severe exacerbations in the past 12 months
  • low socio-economic status
  • environmental irritants
  • African-American ethnicity
  • vitamin D deficiency
  • obesity
  • younger age
  • low parental education
  • bacterial infection
  • emotion
  • non-steroidal anti-inflammatory drug (NSAID) use
More risk factors

Diagnostic investigations

1st investigations to order

  • response to treatment with a short-acting beta-2 agonist
  • peak expiratory flow rate or FEV₁
  • oxygen saturation
More 1st investigations to order

Investigations to consider

  • arterial or venous blood gases
  • chest x-ray
More investigations to consider

Treatment algorithm

ACUTE

life-threatening exacerbation or impending respiratory failure

severe exacerbation

mild to moderate exacerbation

Contributors

Authors

Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD

Respiratory and Sleep Physician

The Children's Hospital at Westmead

Clinical Associate Professor

Discipline of Paediatrics and Child Health

Sydney Medical School

University of Sydney

Sydney

New South Wales

Australia

Disclosures

PDR declares that he has no competing interests.

Anne Chang, MBBS, FRACP, MPHTM, PhD

Professor

Menzies School of Health Research

Charles Darwin University

Northern Territory

Respiratory and Sleep Physician

Queensland Children's Hospital

Queensland University of Technology

Brisbane

Australia

Disclosures

AC's institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC also received fees from UpToDate for writing topics on cough in children. AC is an author of references cited in this topic.

Peer reviewers

Lucille A. Lester, MD

Professor of Pediatrics

University of Chicago Comer Children's Hospital

Chicago

IL

Disclosures

LAL declares that she has no competing interests.

Caro Minasian, BSc (Hons), MB, BS, FCPCH, MD (Res)

Consultant in Paediatrics

Adolescent Medicine & Paediatric Respiratory Medicine

University College London Hospitals NHS Foundation Trust

London

UK

Disclosures

CM declares that he has no competing interests.

  • Acute asthma exacerbation in children images
  • Differentials

    • Inhaled foreign body
    • Viral-induced infantile wheezing
    • Aspiration
    More Differentials
  • Guidelines

    • Global strategy for asthma management and prevention
    • Australian asthma handbook
    More Guidelines
  • Patient leaflets

    Asthma in children: what is it?

    Asthma in children: what treatments work?

    More Patient leaflets
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