Acute asthma exacerbation in children

Acute asthma exacerbations in children typically present with expiratory wheeze and a varying degree of respiratory distress.

Triggers include viral or bacterial infection, inhaled allergens, environmental irritants (including air pollution), emotion, medications, and poor adherence with preventive therapy.

Most children will respond to initial bronchodilator therapy, but oral corticosteroids should be initiated early in those who do not.

Severe exacerbations 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 exacerbations may require noninvasive ventilation or intubation. The intensive care team should be involved as early as possible.

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. This topic covers the treatment of children up to 11 years of age. Children 12 years and older are treated the same as adults. See Acute asthma exacerbation in adults.