Current therapies for severe asthma exacerbations in children

This article reviews the epidemiology, pathophysiology, and current treatme nt strategies for severe asthma exacerbations in children. The prevalence o f asthma is increasing, as are the markers of this severe disease such as t racheal intubation and death. Inflammation is now recognized as central to the pathophysiology of asthma, and inflammation control is the cornerstone of therapy. Therapies for severe asthma continue to evolve, Parenteral corticosteroids are standard therapy for acute exacerbations and inhaled corticosteroids ar e the mainstay of chronic care, Inhaled beta(2)-adrenergic agents dosed to effect are the first-line treatment for bronchospasm; however, intravenous beta(2)-adrenergic agents can be used in patients who do not improve with c ontinuous inhaled therapy. Inhaled anticholinergics are effective bronchodi lators when used in addition to inhaled beta(2)-adrenergic agents, Aminophy lline, magnesium sulfate, ketamine, and nebulized furosemide are also used to treat severe asthma exacerbations; however, their efficacy as additional therapy to beta(2)-adrenergic agents is not well established. Use of helium oxygen blends have been used to treat severe exacerbations bo th to improve particle deposition of inhaled medications and to decrease wo rk of breathing, Strategies to prevent barotrauma are central to mechanical ventilation. Brief reports and recent clinical experience suggest that sup port modes of ventilation may be useful to avoid use of neuromuscular block ing agents and to allow active exhalation. Inhalational anesthetic gases an d extracorporeal life support have also been used to treat asthma exacerbat ions that did not improve with conventional care.