Gaps in practice

January/February 2011

Management of severe asthma in children

Volume 40, No.1, January/February 2011 Pages 35-38

Adriana Yock Corrales

Manuel Soto-Martinez

Mike Starr


Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease. When uncontrolled, asthma can place significant limits on daily life, and is sometimes fatal.


This article describes the initial assessment and management of status asthmaticus in children.


Status asthmaticus is a medical emergency in which asthma symptoms are refractory to initial bronchodilator therapy. Patients may report chest tightness, rapidly progressive shortness of breath, dry cough and wheezing. Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to potent allergens or irritants, or after exercise in a cold environment, however, they can also present with sudden onset of symptoms with an unknown trigger. Early recognition and initiation of therapy is vital in preventing severe complications such as respiratory failure. Aggressive treatment with beta-agonists, anticholinergics and corticosteroids remains the gold standard for this condition.

Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalisations.1 The most recent National Heart Lung and Blood Institute (NHLBI) expert panel guidelines on the diagnosis and management of asthma define asthma as a common chronic disorder of the airways that is complex and characterised by variable and recurring symptoms, airflow obstruction, bronchial hyper-responsiveness and underlying inflammation. The interaction of these features of asthma determines the clinical manifestations, disease severity and response to treatment.2 Exacerbations of asthma are episodes of progressive increase in shortness of breath, cough, wheezing or chest tightness. Status asthmaticus is a condition of progressively worsening bronchospasm and respiratory dysfunction due to asthma, which is unresponsive to conventional therapy and may progress to respiratory failure (with the need for mechanical ventilation) or death.3 Children presenting with severe acute exacerbations of asthma should be referred to a hospital for further assessment and monitoring. However, initial emergency management will need to be instituted in the community setting before transfer.

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