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In the research study "Corticosteroid Timing and Length of Stay for Children With Asthma in the Emergency Department," the authors conducted a retrospective medical record review of children with emergency department (ED) visits to a Connecticut Medical Center in 2007. Their aim was to determine whether administration of oral corticosteroids to patients with acute asthma exacerbation would decrease the mean length of stay in the ED by 10 min or more. We review and critique this article and use a case study module to illustrate the importance of these research findings and also the larger body of evidence supporting the early administration of corticosteroids in acute asthma.

To examine the time-dependent changes of spirometry (percent-predicted forced expiratory volume in 1 second [%FEV(1)]) and the Pediatric Respiratory Assessment Measure (PRAM) during the treatment of acute asthma exacerbations.We conducted a prospective study of participants aged 5-17 years with acute asthma exacerbations managed in a Pediatric Emergency Department. %FEV(1) and the PRAM were recorded pretreatment and at 2 and 4 hours. We examined responses at 2 and 4 hours following treatment and assessed whether the changes of %FEV(1) and of the PRAM differed during the first and the second 2-hour treatment periods.Among 503 participants, median [interquartile range, IQR] age was 8.8 [6.9, 11.4], 61% were male, and 63% were African-American. There was significant mean change of %FEV(1) during the first (+15.4%; 95% CI 13.7 to 17.1; p.0001), but not during the second (+1.5%; 95% CI -0.8 to 3.8; p = .21), 2-hour period and of the PRAM during the first (-2.1 points; 95% CI -2.3 to -1.9; p.0001) and the second (-1.0 point; 95% CI -1.3 to -0.7; p.0001) 2-hour periods.Most improvement of lung function and clinical severity occur in the first 2 hours of treatment. Among pediatric patients with acute asthma exacerbations, the PRAM detects significant and clinically meaningful change of severity during the second 2-hour treatment, whereas spirometry does not. This suggests that spirometry and clinical severity scores do not have similar trajectories and that clinical severity scores may be more sensitive to clinical change of acute asthma severity than spirometry.

Increased asthma morbidity and mortality is associated with inappropriate home self-management skills.To examine the proportion of children presenting to the emergency department (ED) with an acute asthma exacerbation with incorrect home use of their albuterol inhaler and to identify factors associated with improper treatment.Caregivers of children with asthma aged 4 to 14 years, presenting to the ED with an asthma exacerbation, participated in the study. Interviewers collected caregiver's perceived severity of the asthma exacerbation and home albuterol use before the ED visit. National Asthma Education and Prevention Program guidelines were used to classify home albuterol use as appropriate or inappropriate.Home albuterol use for the current asthma exacerbation was categorized as inappropriate (56 [68%]) and appropriate (26 [32%]) for 84 participants. Thirty-nine of the inappropriate group undertreated, with 24 not giving albuterol frequently enough and 15 without albuterol at home. Other reasons for incorrect home albuterol use included: no spacer, overtreating, overreacting, and using a controller medicine for quick relief. Those with appropriate albuterol use were more likely to have their child hospitalized for asthma in the past 48 months (P=.004). Caregivers with inappropriate use perceived their child's asthma exacerbation as more severe (P.001) compared with physician rating. Physicians rated asthma severity higher in the appropriate group than the inappropriate group (P.001).A significant proportion of caregivers incorrectly treat children's asthma exacerbation with albuterol. Despite perceiving their children's asthma exacerbations as more severe, most undertreat with albuterol. Correctly assessing asthma symptom severity and appropriate home albuterol use may be linked to disease experience.

Children with acute asthma exacerbations frequently present to an emergency department with signs of respiratory distress. The most severe episodes are potentially life-threatening. Effective treatment depends on the accurate and rapid assessment of disease severity at presentation. This statement addresses the assessment, management and disposition of paediatric patients with a known diagnosis of asthma who present with an acute asthma exacerbation, especially preschoolers at high risk for persistent asthma. Guidance includes the assessment of asthma severity, treatment considerations, proper discharge planning, follow-up, and prescription for inhaled corticosteroids to prevent exacerbation and decrease chronic morbidity.Les enfants ayant des exacerbations aiguës de l’asthme consultent souvent à l’urgence parce qu’ils présentent des signes de détresse respiratoire. Les crises les plus graves peuvent mettre en jeu le pronostic vital. L’efficacité du traitement dépend de l’évaluation exacte et rapide de la gravité de la maladie à la présentation. Le présent document de principes porte sur l’évaluation, la prise en charge et la conduite à tenir auprès des patients pédiatriques ayant un diagnostic connu d’asthme qui consultent en raison d’une exacerbation aiguë de l’asthme, notamment les enfants d’âge préscolaire très vulnérables à un asthme persistant. Les conseils incluent l’évaluation de la gravité de l’asthme, les considérations thérapeutiques, la planification convenable du congé, le suivi et une prescription de corticoïde par aérosol pour prévenir les exacerbations et réduire la morbidité chronique.

All patients with asthma are at risk of having asthma exacerbations characterized by worsening symptoms, airflow obstruction, and an increased requirement for rescue bronchodilators. The goals of managing an asthma exacerbation are prompt recognition and rapid reversal of airflow obstruction to avert relapses and future episodes. Short-acting beta-agonists, oxygen, and corticosteroids form the basis of management of acute asthma exacerbation, but a role is emerging for anticholinergics and newer agents such as levalbuterol and formoterol. Initiation or intensification of long-term controller therapy, treatment of comorbid conditions, avoidance of likely triggers, and timely follow-up care prevent setbacks. Acceptance of current treatment guidelines by physicians and adherence to the recommended clinical regimens by patients are essential for effective management of asthma. The physician should strive to establish a constructive relationship with the patient by addressing the patient's concerns, reaching agreement on the goals of therapy, and developing a written action plan for patient self-management.

Foreign body aspiration in adults has a variety of clinical presentations and often goes unrecognized. We describe the case of a patient who experienced crack cocaine aspiration and presented with symptoms of an acute asthma exacerbation requiring mechanical ventilation until the eventual diagnosis and bronchoscopic removal of the foreign body.

Commentary on: Keeney GE, Gray MP, Morrison AK, et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics 2014;133:493–9[OpenUrl][1][Abstract/FREE Full Text][2] Standard of care for emergency department (ED) treatment of children with acute asthma exacerbation includes systemic steroids.1 Traditionally, the systemic steroid course of choice has been a 5-day burst of oral prednisone or prednisolone. Recent studies have begun to show that a shorter course of dexamethasone may have comparable efficacy.2–4 Dexamethasone is an attractive alternative to prednisone and prednisolone because of its longer duration of metabolic effect and subsequent shorter treatment duration. Others have touted the palatability of dexamethasone over that of prednisone and prednisolone, as well as potentially improved clinical outcomes and cost savings due to superior compliance with the shorter treatment course dexamethasone requires.5 This was a … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.2013-2273%26rft_id%253Dinfo%253Apmid%252F24515516%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=133/3/493&atom=%2Febmed%2F19%2F5%2F175.atom

Asthmatic patients receive multiple drugs as part of their treatment program. When a subsequent allergic reaction occurs, the ethylenediamine component of aminophylline is usually not suspected as the etiologic agent. We present a case of ethylenediamine-induced delayed hypersensitivity reaction in a 46-year-old woman who received parenteral aminophylline for an acute asthma exacerbation. Patch testing for ethylenediamine was positive.

Background: Asthma represents a significant percentage of ED visits. Management decisions are based on clinical evaluation. Spirometry and peak flow have been used to monitor control but both are limited by being effort dependent. NEDPFT such as inductance plethysmography and respiratory profile monitor role have not been fully evaluated in ED setting.

Rationale Parental smoking is common in asthmatic children, and we investigated the effect of environmental tobacco smoking (ETS) on the serum concentrations of IgE and eosinophilic cationic protein (ECP). Methods We interviewed parents of 75 asthmatic children to assess ETS history. 75 asthmatic children classified as heavy ETS group, light ETS group, and non-ETS group, who were admitted in Korea University Hospital with acute asthma exacerbation. We compared serum levels of IgE and ECP of 3 groups. Results Asthmatic children groups with ETS history had higher serum IgE levels than non-ETS group (p=0.002) but not in comparison about ECP levels. Serum IgE levels were positively related to the severity of exposures to ETS (r=0.351, p=0.001) and there was no association between levels of ECP and exposures to ETS. Conclusions During acute asthmatic exacerbation, the more asthma children exposed to smoking, the higher IgE levels. Environmental smoking aggravates the airway allergic inflammation which does not relate to ECP but IgE. We suggest that stop smoking should be exaggerated within families of asthma children patient through education.

Source Citation Stoodley RG, Aaron SD, Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: a metaanalysis of randomized clinical trials. Ann Emerg Me...

(1999) J Pediatr 135, 22. Schuh S, Johnson DW, Stephens D . , et al. . Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. . Jul; . : . –7 . [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTION: In children with mild acute asthma, is albuterol (salbutamol) delivered by a metered dose inhaler (MDI) with a spacer (standard low dose or higher, weight adjusted dose) as effective as albuterol delivered by a nebuliser? Randomised (concealed), blinded (patient and outcome assessor), controlled trial. A hospital emergency department in Toronto, Ontario, Canada. 90 children who were 5–17 years of age (mean 9.2 y, mean baseline forced expiratory volume in 1 second [FEV1] 62.8%) who presented with acute asthma exacerbation between 0800 and 2200, could reliably perform pulmonary function testing, and had a baseline FEV1 of 50%–79% of the predicted value. Children were excluded if this was their first wheezing episode, they had used albuterol within 4 hours of the visit, had concurrent cardiopulmonary disease, or had hypersensitivity to albuterol. 30 children were allocated to a standard low dose of albuterol by MDI with a clear plastic 140 ml spacer device with a mouthpiece … [1]: {openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2Bpediatrics%26rft.stitle%253DJ%2BPediatr%26rft.aulast%253DSchuh%26rft.auinit1%253DS.%26rft.volume%253D135%26rft.issue%253D1%26rft.spage%253D22%26rft.epage%253D27%26rft.atitle%253DComparison%2Bof%2Balbuterol%2Bdelivered%2Bby%2Ba%2Bmetered%2Bdose%2Binhaler%2Bwith%2Bspacer%2Bversus%2Ba%2Bnebulizer%2Bin%2Bchildren%2Bwith%2Bmild%2Bacute%2Basthma.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0022-3476%252899%252970322-7%26rft_id%253Dinfo%253Apmid%252F10393599%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0022-3476(99)70322-7&link_type=DOI [3]: /lookup/external-ref?access_num=10393599&link_type=MED&atom=%2Febnurs%2F3%2F1%2F12.atom [4]: /lookup/external-ref?access_num=000081378900007&link_type=ISI

SummaryObjectives(1) Compare ideal cut-off points for DS and %FEV1 at 1 and 3 h to predict hospitalization/relapse in subjects with moderate to severe asthma exacerbation (2) Develop a multivariate regression model using DS, %FEV1, demographic, and clinical variables to predict hospitalization/relapse.MethodsSubjects with acute exacerbation of asthma (FEV1