Acute Exacerbation of Asthma in Children

Asthma is the most common chronic disease affecting children worldwide, with 11-14% of children reporting symptoms. The global prevalence is rising, and the economic burden is significant, with the US alone incurring approximately $726 million annually due to parental work absences. Acute asthma exacerbations are associated with high morbidity and, in rare cases, mortality. Approximately 3 million exacerbations occur each year in children under 18. Timely and appropriate management is crucial to saving lives.

Common Triggers

Respiratory viruses are the primary triggers for asthma exacerbations, accounting for around 85% of cases. Human rhinovirus is responsible for 74% of these exacerbations, while other viruses like respiratory syncytial virus and influenza also play a role. Other triggers include allergens, medications, exercise, and environmental irritants.

Symptoms and Monitoring

Asthma exacerbations often cause rapid breathing and chest indrawing. In severe cases, abdominal and neck muscle indrawing may also be observed, especially in very young children. Home pulse oximetry can help monitor oxygen levels. In mild cases, oxygen saturation may remain normal, but moderate to severe cases often see levels drop below 94%. Children may appear cranky, agitated, or drowsy as the exacerbation worsens. Early recognition and prompt medical intervention are essential to prevent lung injury and potentially save the child’s life.

Risk Factors for Severe Outcomes

1. 1. Previous severe exacerbations requiring intubation or ICU admission.
   2. More than 2 hospitalizations for asthma in the past year.
   3. More than 3 emergency department visits for asthma in the past year.
   4. Use of more than 2 canisters of Albuterol per month.
   5. Difficulty in perceiving the severity of symptoms.
   6. Lack of a written asthma action plan.
   7. Current or recent use of oral corticosteroids.
   8. Food allergies.
   9. Other chronic lung diseases

When to Seek Medical Care

1. Symptoms are not relieved promptly with inhaled albuterol.
2. More than 6 puffs of albuterol are needed for relief within the first 2 hours.
3. No improvement after 24 hours.
4. Persistent concerns from the patient or parent.
5. Severe symptoms or low oxygen saturation.
6. Presence of any listed risk factors.

For more detailed information, refer to Leung JS, Drugs in Context 2021; 10: 2020-12-7.