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Acute asthma exacerbation refers to the progressive deterioration of asthma symptoms that is always triggered by virus infection represented by respiratory syncytial virus (RSV). After RSV infection, exaggerated Th2‐mediated pulmonary inflammation is the critical pathological response of asthmatic patients with acute exacerbation. Significantly, airway epithelial cells, being the primary targets of RSV infection, play a crucial role in controlling the pulmonary inflammatory response by releasing airway epithelial cell‐derived exosomes (AEC‐Exos), which potentially influence the development of asthma. However, the specific role of AEC‐Exos in acute asthma exacerbation after RSV infection remains obscure. The purpose of this study was to determine the distinct function of AEC‐Exos in exacerbating acute asthma following RSV infection. Blockade of exosomes by GW reduce the enhanced pulmonary inflammation significantly. Specifically, the enhanced Th2 inflammation was induced by AEC‐Exos thorough transportation of hsa‐miR‐155‐5p–Sirtuin 1 (SIRT1) pathway during acute asthma exacerbation. Targeted inhibition of hsa‐miR‐155‐5p blocks the exaggerated Th2 inflammation effectively in mice with acute asthma exacerbation. In summary, our study showed that during acute asthma exacerbation after RSV infection, AEC‐Exos promote the enhanced Th2 inflammation through transportation of increased hsa‐miR‐155‐5p, which was mediated partly through SIRT1‐mediated pathway. hsa‐miR‐155‐5p is a potential biomarker for early prediction of acute asthma exacerbation. [ABSTRACT FROM AUTHOR]

Background: Little is known about the immune responses during acute asthma exacerbation. In this study, we examined immune responses in children following an acute asthma exacerbation. Methods: We evaluated pro‐inflammatory cytokine levels and gene expression profiles in blood samples from pediatric patients admitted for acute asthma exacerbation. Viral PCR was performed to differentiate between viral or non‐viral‐associated exacerbations. Results: Following informed consent, clinical data were obtained from 20 children with asthma (median [interquartile range, IQR]: age 11.5 [8.0, 14.2]) years and 14 healthy age‐matched controls (10.5 [7.0, 13.0]). Twelve had positive nasopharyngeal Polymerase chain reaction (PCR) for viral infection (11 rhinoviruses and 1 respiratory syncytial virus (RSV)). Nine were in the pediatric intensive care unit (PICU) and among them five required continuous positive airway pressure (CPAP). Mean (±SD) days on systemic steroids before drawing blood sample were 2.5 ± 1.6. Twelve had history of environmental allergies with 917 (274, 1396) IU/mL total IgE (median (IQR)). Compared with controls, IL‐1RA and IL‐10 levels were significantly increased and TNF‐α significantly decreased in asthma subjects (p <.05 for all). RNA‐seq analysis revealed 852 differentially expressed genes in subjects with asthma. Pathway analysis found upregulated genes and pathways involved in innate immune responses in subjects with asthma. Significantly reduced genes included pathways associated with T helper cell differentiation and activation. Conclusions: In acute asthma exacerbation, innate immune pathways remained increased while adaptive immune responses related to T helper cells are blunted and are independent of trigger or asthma severity. Our novel findings highlight the need to identify new therapies to target persistent innate immune responses to improve outcomes in acute asthma. [ABSTRACT FROM AUTHOR]

Abstract Acute asthma exacerbation refers to the progressive deterioration of asthma symptoms that is always triggered by virus infection represented by respiratory syncytial virus (RSV). After RSV infection, exaggerated Th2‐mediated pulmonary inflammation is the critical pathological response of asthmatic patients with acute exacerbation. Significantly, airway epithelial cells, being the primary targets of RSV infection, play a crucial role in controlling the pulmonary inflammatory response by releasing airway epithelial cell‐derived exosomes (AEC‐Exos), which potentially influence the development of asthma. However, the specific role of AEC‐Exos in acute asthma exacerbation after RSV infection remains obscure. The purpose of this study was to determine the distinct function of AEC‐Exos in exacerbating acute asthma following RSV infection. Blockade of exosomes by GW reduce the enhanced pulmonary inflammation significantly. Specifically, the enhanced Th2 inflammation was induced by AEC‐Exos thorough transportation of hsa‐miR‐155‐5p–Sirtuin 1 (SIRT1) pathway during acute asthma exacerbation. Targeted inhibition of hsa‐miR‐155‐5p blocks the exaggerated Th2 inflammation effectively in mice with acute asthma exacerbation. In summary, our study showed that during acute asthma exacerbation after RSV infection, AEC‐Exos promote the enhanced Th2 inflammation through transportation of increased hsa‐miR‐155‐5p, which was mediated partly through SIRT1‐mediated pathway. hsa‐miR‐155‐5p is a potential biomarker for early prediction of acute asthma exacerbation.

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p

Background: Social determinants of health have a significant impact on asthma outcomes, and factors such as income level and neighborhood environment have crucial roles., Objective: This study aimed to assess the impact of the Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related emergency department and urgent care (ED/UC) visits in adults with mild asthma., Methods: This retrospective cohort study used administrative data from Kaiser Permanente Southern California among 198,873 adult patients with mild asthma between January 1, 2013 and December 31, 2018. We employed robust Poisson regression models, adjusted for age and sex, to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and body mass index categories to explore potential disparities in asthma outcomes., Results: Among the cohort, 12,906 patients (6.5%) experienced AAE in 1 year, and Black patients had the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (adjusted risk ratio = 1.11-1.27), with similar trends across body mass index categories and race or ethnicity, except for Black patients. The TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within 1 year. Higher NDI quintiles were associated with higher ED/UC visit risk (adjusted risk ratio = 1.23-1.75) whereas TCI associations were weaker., Conclusion: Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing health care use, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Although individuals with mild asthma account for 30% to 40% of acute asthma exacerbations (AAEs), relatively little attention has been paid to risk factors for AAEs in this population., Objective: To identify risk factors associated with AAEs in patients with mild asthma., Methods: This was a retrospective cohort study. We used administrative data from a large managed care organization to identify 199,010 adults aged 18 to 85 years who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. We then used information at the index visit or from the year before the index visit to measure potential risk factors for AAEs in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing. Poisson regression models with robust SEs were used to estimate the adjusted risk ratios for future AAEs., Results: In the study cohort, mean age was 44 years and 64% were female; 6.5% had AAEs within 1 year after the index visit. In multivariate models, age, sex, race, ethnicity, smoking status, body mass index, prior acute asthma care, and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk., Conclusion: Population-based disease management strategies for asthma should be expanded to include people with mild asthma in addition to those with moderate to severe disease., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

We examined asthma control in children hospitalized for status asthmaticus 7–10 days after discharge with or without an additional prescription for systemic corticosteroids. This was a prospective observational study of patients aged 5–17 years with a documented history of asthma or β-agonist responsive wheezing admitted to the hospital for an acute asthma exacerbation. We compared patients who had any systemic corticosteroid prescribed at discharge with those who were not prescribed systemic corticosteroids at discharge. The primary outcomes were asthma control after discharge, as defined by the Asthma Control Test (ACT), and missed school days, which we modeled with multivariable linear and Poisson regression, respectively. A total of 56 patients were included in the study, 29 (52%) received dexamethasone inpatient and then were discharged without additional prescribed systemic corticosteroids. Those without a corticosteroid prescription at discharge were less likely to have received noninvasive ventilation (p = 0.02), pulmonology consultation (p = 0.02), and continuous albuterol (p = 0.01) during hospitalization. These patients also tended toward shorter length of stay (p = 0.07) compared to those receiving systemic corticosteroid prescription at discharge. In multivariable models, being discharged without systemic corticosteroid prescription was associated with poorer asthma control after discharge [beta (95% CI), –2.21 (–2.65 to –1.77)] and more missed school days [coefficient estimate (95% CI), 0.87 (0.07–1.68)]. After hospitalization for an asthma exacerbation, patients not given systemic corticosteroids at discharge tended to have worse asthma control following discharge despite having less severe disease and requiring less aggressive inpatient management. Supplemental data for this article can be accessed at publisher's website. [ABSTRACT FROM AUTHOR]

Background: Exacerbations of acute asthma are frequent presentations to the Emergency Department (ED) and contribute to ED overcrowding and healthcare cost. The purpose of this study was to evaluate whether ED clinicians are implementing secondary asthma prevention measures prior to discharging patients after an acute asthma exacerbation and also to determine whether ED clinicians are able to correctly demonstrate how to use an asthma metered dose inhaler (MDI) device.Methods: Consenting doctors employed at four EDs situated in the Gauteng province of South Africa were asked to complete a questionnaire and thereafter demonstrate the technique of using an MDI device. Collected data was presented using descriptive statistics.Results: Eighty-six doctors were included in the study. Of these, 18 (20.9%) routinely checked that inhaler technique was correct, 50 (58.1%) routinely enquired regarding adherence to their asthma treatment, 8 (9.3%) routinely informed patients of the side effects of asthma medication, 16 (18.6%) routinely provided patients with a written asthma action plan, 7 (8.1%) routinely evaluated for the presence of concurrent allergic rhinitis and 53 (61.6%) routinely counselled patients regarding smoking cessation. With regards to correctly demonstrating how to use an MDI device, only 23 (26.74%) physician participants performed all eight steps correctly.Conclusion: This study indicates that secondary asthma prevention measures are not adequately addressed by clinicians prior to discharging patients from the ED after an acute asthma attack. It is recommended that ED clinicians are educated with regards to the importance of these measures. [ABSTRACT FROM AUTHOR]

Background The role of bacterial pathogens in exacerbations of bronchial asthma is unclear as that of viral infections. Aim To identify sputum bacteria and antibiotic sensitivity in patients with bronchial asthma exacerbation. Patients and methods A descriptive cross-sectional study was conducted on 50 patients with acute bronchial asthma exacerbation. Spirometeric pulmonary function tests, total and differential leukocyte count, sputum Gram stain, culture, and sensitivities were done for all patients. Results Of the studied patients, 50% have growth of normal flora, 12% have fungal growth, and 38% have bacterial growth (63.6 and 36.4% of them have Gram-negative and Gram-positive bacteria, respectively). The most predominant bacteria were Klebsiella pneumoniae (31.8%) and Streptococcal pneumoniae (18.2%), while Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii complex, and Enterobacter aerogenes are equally distributed (9.1%). There was a significant decrease of vital capacity %, forced vital capacity %, and forced expiratory volume in the 1 s % in bronchial asthma with Gram-negative bacteria compared with those with Gram-positive bacteria. The total and differential leukocytic counts nonsignificantly differed between both subgroups. Among the studied patients with bacterial growth, Amikacin, Quinupristin/Dalfopristin, Linezolid, Vancomycin, and Tigecycline were the most common sensitive antibiotics (100%), followed by Tobramycin, Ciprofloxacin, Levofloxacin, and Gentamicin (95.5%). On the other hand, Benzylpenicillin and Oxacillin were the most common resistant antibiotics (100%), followed by Ampicillin (92.3%). Conclusion Bacterial organisms were responsible for only about one-third of bronchial asthma exacerbation, with predominance of Gram-negative organisms. Amikacin, Quinupristin/Dalfopristin, Linezolid, Vancomycin, and Tigecycline, Tobramycin, Ciprofloxacin, Levofloxacin, and Gentamicin were the most common sensitive antibiotics. Benzylpenicillin, Oxacillin and Ampicillin were the most common resistant antibiotics.

Abstract Objective Albuterol is a β2‐agonist and causes an intracellular shift of potassium from the interstitium. Whole‐body hypokalemia is known to cause skeletal muscle weakness, but whether this occurs as a result of hypokalemia from the intracellular shift during albuterol treatment is unknown. We sought to determine if albuterol total dose or route of administration (nebulization and/or metered‐dose inhaler) is associated with skeletal muscle weakness. Methods This was a prospective observational study using convenience sampling. Skeletal muscle strength was measured before and after 1 hour of albuterol treatment using a hand‐grip dynamometer in participants aged 5–17 years with acute asthma exacerbation in the emergency department. We examined associations of albuterol dose and route of administration with changes in grip strength. Results Among 50 participants, 10 received continuous albuterol by nebulizer and 40 received albuterol by metered‐dose inhaler. The median (interquartile range) in change of grip was ‐7.8% (interquartile range, ‐23.3, +5.1) for those treated with a nebulizer and +2.4% (interquartile range, ‐5%, +12.7%) for those treated with a metered‐dose inhaler (P = 0.036 for the difference). In a multiple linear regression model adjusted for the pretreatment Acute Asthma Intensity Research Score and age, participants treated with a nebulizer had a 12.9% decrease in skeletal muscle strength compared with those treated with a metered‐dose inhaler. Conclusion Higher doses of albuterol administered via nebulization result in decreased skeletal muscle strength in patients with acute asthma; whereas, albuterol administration via metered‐dose inhalers showed no effect on skeletal muscle strength.

Background: Asthma exacerbations result in significant health and economic burden, but are difficult to predict.Research Question: Can machine learning (ML) models with large-scale outpatient data predict asthma exacerbations?Study Design and Methods: We analyzed data extracted from electronic health records (EHRs) of asthma patients treated at the Cleveland Clinic from 2010 through 2018. Demographic information, comorbidities, laboratory values, and asthma medications were included as covariates. Three different models were built with logistic regression, random forests, and a gradient boosting decision tree to predict: (1) nonsevere asthma exacerbation requiring oral glucocorticoid burst, (2) ED visits, and (3) hospitalizations.Results: Of 60,302 patients, 19,772 (32.8%) had at least one nonsevere exacerbation requiring oral glucocorticoid burst, 1,748 (2.9%) requiring and ED visit and 902 (1.5%) requiring hospitalization. Nonsevere exacerbation, ED visit, and hospitalization were predicted best by light gradient boosting machine, an algorithm used in ML to fit predictive analytic models, and had an area under the receiver operating characteristic curve of 0.71 (95% CI, 0.70-0.72), 0.88 (95% CI, 0.86-0.89), and 0.85 (95% CI, 0.82-0.88), respectively. Risk factors for all three outcomes included age, long-acting β agonist, high-dose inhaled glucocorticoid, or chronic oral glucocorticoid therapy. In subgroup analysis of 9,448 patients with spirometry data, low FEV1 and FEV1 to FVC ratio were identified as top risk factors for asthma exacerbation, ED visits, and hospitalization. However, adding pulmonary function tests did not improve models' prediction performance.Interpretation: Models built with an ML algorithm from real-world outpatient EHR data accurately predicted asthma exacerbation and can be incorporated into clinical decision tools to enhance outpatient care and to prevent adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute asthma exacerbation is one of the most common reasons for paediatric emergency room visits and hospital admissions in the United States of America., Objective: To assess the impact of CHD on outcomes of children hospitalised for acute asthma exacerbation., Methods: Children primarily admitted for acute asthma exacerbation were sampled from 2006, 2009, 2012, and 2016 kid inpatient database of the Healthcare Cost and Utilization Project using ICD codes. The disease outcomes were compared between those with and without CHD using multivariate logistic regressions in Stata version 17., Results: There were a total of 639,280 acute asthma exacerbation admissions, of which 5,907 (0.92%) had CHD. The mortality rate was 0.079% for patients without CHD and 0.72% for those with co-existing CHD. Children with CHD had higher odds of mortality (5.51, CI 3.40-8.93, p < 0.001), acute respiratory failure (2.84, CI 2.53-3.20; p < 0.001), need for invasive mechanical ventilation (4.58, CI 3.80-5.52; p < 0.001), acute kidney injury (adjusted odds ratio 3.03, CI 3.03-7.44; p < 0.001), and in-hospital cardiac arrest (adjusted odds ratio 4.52, CI 2.49-8.19; p < 0.001) when compared with those without CHD. The adjusted mean length of hospital stays (CI 2.91-3.91; p < 0.001) and hospital charges (95% CI $31060-$47747) among children with acute asthma exacerbation and CHD were significantly higher than in those without CHD., Conclusion and Significance: CHD is an independent predictor of mortality, more severe disease course, and higher hospital resource utilisation. Strategies that improve CHD care will likely improve the overall health outcomes of children with CHD hospitalised for acute asthma exacerbation.

Background: Ipratropium bromide (IB), when administered with β2‐agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered‐dose inhaler (MDI), can, reportedly, shorten patients' length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI‐delivered IB in pediatric patients with acute asthma exacerbation. Methods: This prospective, non‐randomized, observational study included patients aged ≥4 years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20‐min intervals. IB use was determined by the physicians' treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration. Results: Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score‐matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non‐IB group: 31.5%; P = 0.67). The post‐treatment modified pulmonary index scores (mean ± SD) were also similar (IB: 6.6 ± 2.0 vs non‐IB: 6.3 ± 2.5; P = 0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously. Conclusion: The metered‐dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In our case reports, we mentioned about the utility of NPPV therapy in addition to standard pharmacologic therapy for acute asthma exacerbations in pregnant women with dyspnea and hypoxemia compared with that of oxygen therapy alone. Careful patient selection and clinicians' NPPV experience are crucial in optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

With our study, we searched the medical literature to find magnesium (Mg) correlation with Emergency situations or its use in Emergency Medicine. Our aim is to fill the gap that we find in our daily routine between Mg studies on its role in Emergency and the real conception that doctors have of it in medical practice. We searched the literature for terms as magnesium or magnesium sulphate, magnesium in emergency, eclampsia, arrhythmias, acute asthma exacerbation, magnesium, and pediatric population. After a thorough research, we divided our discoveries into chapters to sort out a large amount often discordant articles. [ABSTRACT FROM AUTHOR]

The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation. In addition to specifics relating to endotracheal intubation, we also discuss the interpretation of ventilator graphics, the recommended mode of ventilation, dynamic hyperinflation, permissive hypercapnia, as well as the role of extracorporeal membrane oxygenation and noninvasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

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Introduction The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care. Method The three stages of the project included (a) identification of criteria in a literature review, (b) validation of the criteria by an expert panel, and (c) adaptation of the criteria in the design of an assessment tool. Results The criteria were validated and adapted in the design of The Pediatric Acute Asthma Exacerbation Severity Assessment and Disposition Decision-Making Tool for Pediatric Primary Care. Discussion The adaptation of criteria derived from the evidence and validated by an expert panel will inform and guide clinicians in assessing severity and support decision making in determining disposition of pediatric patients presenting with an acute asthma exacerbation in primary care. [ABSTRACT FROM AUTHOR]

The objectives were to identify factors associated with early revisit of adult patients with acute asthma exarcebation discharged from the Emergency Department (ED). It was a retrospective cohort study with patients aged 12 years or more within a period of 1 month and who were treated for acute asthma and discharged from the ED of Sarawak General Hospital. A total of 397 patients fulfilled sampling criteria and out of this number, 13.9% had revisit to the ED within 2 weeks. In all of these revisit cases, 9.1% were actually admitted. Prescription rate of oral corticosteroid was found to be low (24.9%) and abscond rate was high (25.1%). Patients who absconded from the ED and their concurrent infection were associated with early ED revisit. [ABSTRACT FROM AUTHOR]

This study examines caregiver preferences of single-dose dexamethasone (DEX) versus 5-day oral prednisolone in treating acute asthma exacerbation in a pediatric emergency department (PED). A secondary objective was preference for mode of home inhaled β-agonist administration. Caregivers of patients 2 to 18 years with an acute asthma exacerbation treated in the PED completed a 1-page questionnaire including asthma history and preferences for steroids and β-agonist administration. One hundred caregivers completed the questionnaire. Within the preceding year, 79% had an asthma exacerbation and 73.7% (n = 99) were prescribed prednisolone. DEX was preferred by 79% of caregivers. Preferences were independent of caregiver demographics except in cases of prior intensive care admission, where DEX was less favored (odds ratio = 0.27, P < .046). No difference existed in mode of home β-agonist administration. Most caregivers prefer DEX in acute asthma exacerbation management. No difference exists for home β-agonists. These results may advise clinical practice in pediatric acute asthma exacerbation. [ABSTRACT FROM PUBLISHER]

Background Early identification of the severity of asthma exacerbation would be helpful for the management of patients. We aimed to evaluate the correlation of morphological change in activated eosinophils and the severity of an asthma exacerbation. Methods Blood was collected from 55 asthmatic children: 40 of whom were having an exacerbation, 15 symptom-free, and 15 healthy controls. The percentage of eosinophils with morphological changes (emission of single or multiple pseudopods, presence of cytoplasmic vacuoles, releasing a small, moderate, or large quantity of granules, spreading, eosinophil death, and presence of cluster of free eosinophil granules) was quantified after the adherence to a slide and compared using the Mann-Whitney test. The correlation between the severity of the asthma exacerbation and the percentage changed eosinophils was tested with Spearman's correlation. Results The proportion of activated eosinophils was higher in asthmatic symptom-free children than in the control group, and acute asthma exacerbation produced an additional increase in eosinophil activation ( P < 0.01). More significantly increased morphological changes were emissions of multiple pseudopods, presence of cytoplasmic vacuoles, spreading, and presence of a cluster of free eosinophil granules ( P < 0.001). The following were correlated with the severity of an asthma exacerbation: ≥14% of eosinophils emitting single pseudopod, 8% emitting multiple pseudopods, 17% with vacuoles, 28% eosinophils releasing a large quantity of granules, and 66% of spread eosinophils. Conclusions Quantifying the morphological changes in eosinophils is a feasible, easy, and reliable manner to identify the severity of an asthma exacerbation and therefore might improve the clinical management of asthmatic children. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to evaluate the relationship between time of corticosteroid administration to children with asthma exacerbations in the Emergency Department (ED) and length of stay (LOS). We hypothesized administration within 60 minutes would be associated with a 10- minute or greater decrease in mean LOS. Methods. A retrospective chart review of 882 patients was conducted. Children between the ages of 2 and 18 years presented to the Connecticut Children's Medical Center's (CCMC's) ED with an acute asthma exacerbation were included. Children were excluded if they did not receive oral corticosteroids in the ED, had significant co-morbidities, were currently taking corticosteroids, or had taken them within the past 7 days. Children receiving corticosteroids within 60 minutes of triage were compared with children receiving corticosteroids for 61 minutes or later. The primary outcome was mean LOS. Results. Children treated with corticosteroids within 60 and 61 minutes or later had similar age, gender, insurance, and disposition. Children treated with corticosteroids within 60 minutes had a 25-minute decrease in LOS compared with children treated for 61-minute or later (95% CI: 15-35), p < .0001. Conclusions. Administering corticosteroids to pediatric asthma patients in the ED within an hour of triage is associated with a 25-minute mean decrease in LOS. With large numbers of asthma visits, a 25-minute decrease in LOS for each child could have a significant impact on patient throughput in the ED. [ABSTRACT FROM AUTHOR]

Abstract: Background: Limited evidence is available on the use of budesonide inhalation suspension (BIS) for the treatment of mild to severe acute asthma exacerbations (AAE) in adults in an inpatient setting. This study was conducted to evaluate the efficacy of a five-day course of BIS compared with oral prednisolone (OP) in the management of adults with AAE. Methods: A retrospective study examined the response of 28 patients hospitalized with mild to severe acute asthma exacerbation from January 2003 to December 2003. These patients, who were steroid free ≥1 yr, were administered a five-day course of BIS (2 × 2 mg bid) or OP (2 × 15 mg bid). PEF, FEV1 and asthma symptom scores were recorded daily. Results: The BIS (n = 13) and OP (n = 15) treatment groups were comparable at baseline for demographic characteristics and prebronchodilator (fenoterol) FEV1 of 52.4% predicted normal value and 54.6% predicted normal value, respectively. Mean change of morning PEF was 152 L/min during BIS treatment and 130 L/min for OP treatment; the mean changes of morning forced expiratory volumes in 1 s (FEV1) were 1.0 and 0.7 L, respectively. The mean change in daytime symptom scores were −1.6 and −1.3 in the BIS and the OP groups, respectively. Improvements in PEF, FEV1 and daytime symptom scores were significantly different between baseline and after treatment in each treatment group (p < 0.05). However, improvements in both BIS and OP groups were similar. Conclusion: Budesonide inhalation suspension may be an alternative treatment of acute asthma exacerbation in adults who are at risk for systemic corticosteroids. [Copyright &y& Elsevier]

Magnesium deficiency is a common electrolyte disorder in patients with acute severe asthma, but intracellular magnesium content better reflects its homeostasis than does its serum concentration. Magnesium takes part in many metabolic processes in the organism, including energy metabolism, protein and nucleic acid synthesis, cell cycle, the binding of substances to the plasma membrane, and maintenance of cytoskeletal and mitochondrial integrity. It also modulates ion transport and influences intracellular calcium concentration. Maintenance of the cells’ transmembrane gradient depends on the presence of magnesium, and hypomagnesemia may result in an increase in neuromuscular cell excitability. Magnesium is a cation modulating the smooth muscle contractility of different tissues: hypomagnesemia causes their contraction and hypermagnesemia their relaxation. Suggestions of a positive influence of magnesium in the treatment of asthma exacerbation have been known for a long time, but research results differ. A single dose of intravenous magnesium sulfate given to patients with acute asthma exacerbation has been shown to be safe, but its efficiency is still under discussion. According to the Global Initiative for Asthma GINA-2005, magnesium sulfate administration is not recommended for routine treatment, but it is permitted in patients with severe asthma exacerbation not responding to treatment (evidence category A). Recommendations of the British Thoracic Society allow one dose of magnesium sulfate to patients with acute severe asthma exacerbation and inadequate initial response to broncho-dilating inhalation treatment (evidence category A). Future investigations should help to establish the indications for magnesium use in the treatment of acute asthma exacerbations as well as the magnesium dose and the scheme of its administration. [ABSTRACT FROM AUTHOR]