Acute asthma exacerbation in children - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute asthma exacerbations in children typically present with expiratory wheeze and a varying degree of respiratory distress.
Triggers include viral or bacterial infection, inhaled allergens, environmental irritants (including air pollution), emotion, medications, and poor adherence with preventive therapy.
Most children will respond to initial bronchodilator therapy, but oral corticosteroids should be initiated early in those who do not.
Severe exacerbations require oxygen, nebulized/intravenous bronchodilators, and intravenous corticosteroids and may require magnesium sulfate infusion, intravenous bronchodilators, and intramuscular epinephrine (if anaphylaxis is present).
Severe and life-threatening exacerbations may require noninvasive ventilation or intubation. The intensive care team should be involved as early as possible.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Normal ranges for respiratory rate and heart rate when awake at rest

Citations

Key Articles

Global Initiative for Asthma. 2024 GINA report, global strategy for asthma management and prevention. May 2024 [Internet publication].[Full Text]
British Thoracic Society/Scottish Intercollegiate Guidelines Network. SIGN 158: British guideline on the management of asthma. A national clinical guideline. Jul 2019 [internet publication].[Full Text]
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.[Abstract][Full Text]
National Asthma Council. Australian asthma handbook. April 2022 [internet publication]. [Full Text]

Referenced Articles

1. Mallol J, Crane J, von Mutius E, et al; ISAAC Phase Three Study Group. The International Study of Asthma and Allergies in Childhood (ISAAC) phase three: a global synthesis. Allergol Immunopathol (Madr). 2013 Mar-Apr;41(2):73-85.[Abstract][Full Text]
2. Serebrisky D, Wiznia A. Pediatric asthma: a global epidemic. Ann Glob Health. 2019 Jan 22;85(1):6.[Abstract][Full Text]
3. Centers for Disease Control and Prevention. Most recent national asthma data. May 2023 [internet publication].[Full Text]
4. American Lung Association. Asthma and children fact sheet. 2023 [internet publication].[Full Text]
5. Becker CD, Scheidegger J, Marincek B. Hepatic vein occlusion: morphologic features on computed tomography and ultrasonography. Gastrointest Radiol. 1986;11(4):305-11.[Abstract]
6. Johnston SL, Pattemore PK, Sanderson G, et al. Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. BMJ. 1995 May 13;310(6989):1225-9.[Abstract][Full Text]
7. Global Initiative for Asthma. 2024 GINA report, global strategy for asthma management and prevention. May 2024 [Internet publication].[Full Text]
8. Greenberg SB. Respiratory consequences of rhinovirus infection. Arch Intern Med. 2003 Feb 10;163(3):278-84.[Abstract][Full Text]
9. Perez A, Lively JY, Curns A, et al. Respiratory virus surveillance among children with acute respiratory illnesses - new vaccine surveillance network, United States, 2016-2021. MMWR Morb Mortal Wkly Rep. 2022 Oct 7;71(40):1253-9.[Abstract][Full Text]
10. Pike KC, Akhbari M, Kneale D, et al. Interventions for autumn exacerbations of asthma in children. Cochrane Database Syst Rev. 2018 Mar 8;3(3):CD012393.[Abstract][Full Text]
11. Singh AM, Busse WW. Asthma exacerbations. 2: Aetiology. Thorax. 2006 Sep;61(9):809-16.[Abstract][Full Text]
12. Biscardi S, Lorrot M, Marc E, et al. Mycoplasma pneumoniae and asthma in children. Clin Infect Dis. 2004 May 15;38(10):1341-6.[Abstract]
13. Custovic A, de Moira AP, Murray CS, et al. Environmental influences on childhood asthma: allergens. Pediatr Allergy Immunol. 2023 Feb;34(2):e13915.[Abstract][Full Text]
14. Agnihotri NT, Saltoun C. Acute severe asthma (status asthmaticus). Allergy Asthma Proc. 2019 Nov 1;40(6):406-9.[Abstract]
15. Torres I. When is TMJ surgery indicated? J Oral Maxillofac Surg. 1987 Feb;45(2):98.[Abstract]
16. Zheng XY, Ding H, Jiang LN, et al. Association between air pollutants and asthma emergency room visits and hospital admissions in time series studies: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138146.[Abstract][Full Text]
17. Lim H, Kwon HJ, Lim JA, et al. Short-term effect of fine particulate matter on children's hospital admissions and emergency department visits for asthma: a systematic review and meta-analysis. J Prev Med Public Health. 2016 Jul;49(4):205-19.[Abstract][Full Text]
18. Nassikas NJ, McCormack MC, Ewart G, et al. Indoor air sources of outdoor air pollution: health consequences, policy, and recommendations: an official American Thoracic Society workshop report. Ann Am Thorac Soc. 2024 Mar;21(3):365-76.[Abstract][Full Text]
19. McArdle CE, Dowling TC, Carey K, et al. Asthma-associated emergency department visits during the Canadian Wildfire Smoke Episodes - United States, April-August 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):926-32.[Abstract][Full Text]
20. Meek HC, Aydin-Ghormoz H, Bush K, et al. Notes from the field: asthma-associated emergency department visits during a wildfire smoke event - New York, June 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):933-5.[Abstract][Full Text]
21. McDonald VM, Archbold G, Beyene T, et al. Asthma and landscape fire smoke: aA Thoracic Society of Australia and New Zealand position statement. Respirology. 2023 Nov;28(11):1023-35.[Abstract][Full Text]
22. Anderson SD. How does exercise cause asthma attacks? Curr Opin Allergy Clin Immunol. 2006 Feb;6(1):37-42.[Abstract]
23. Johnston NW, Sears MR. Asthma exacerbations. 1: epidemiology. Thorax. 2006 Aug;61(8):722-8.[Abstract]
24. Rank MA, Hagan JB, Park MA, et al. The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol. 2013 Mar;131(3):724-9.[Abstract]
25. Reyes-Angel J, Kaviany P, Rastogi D, et al. Obesity-related asthma in children and adolescents. Lancet Child Adolesc Health. 2022 Oct;6(10):713-24.[Abstract]
26. Buelo A, McLean S, Julious S, et al. At-risk children with asthma (ARC): a systematic review. Thorax. 2018 Sep;73(9):813-24.[Abstract][Full Text]
27. Denlinger LC, Phillips BR, Ramratnam S, et al. Inflammatory and comorbid features of patients with severe asthma and frequent exacerbations. Am J Respir Crit Care Med. 2017 Feb 1;195(3):302-13.[Abstract][Full Text]
28. Mallah N, Turner JM, González-Barcala FJ, et al. Gastroesophageal reflux disease and asthma exacerbation: A systematic review and meta-analysis. Pediatr Allergy Immunol. 2022 Jan;33(1):e13655.[Abstract][Full Text]
29. Rose JJ, Krishnan-Sarin S, Exil VJ, et al. Cardiopulmonary impact of electronic cigarettes and vaping products: a scientific statement from the American Heart Association. Circulation. 2023 Aug 22;148(8):703-28.[Abstract][Full Text]
30. Sallard E, Schult F, Baehren C, et al. Viral infection and respiratory exacerbation in children: results from a local German pediatric exacerbation cohort. Viruses. 2022 Feb 27;14(3):491.[Abstract][Full Text]
31. Haselkorn T, Fish JE, Zeiger RS, et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol. 2009 Nov;124(5):895-902.e1-4.[Abstract][Full Text]
32. Nwaru BI, Ekström M, Hasvold P, et al. Overuse of short-acting beta(2)-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020 Apr;55(4):1901872.[Abstract][Full Text]
33. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011 Jun;105(6):930-8.[Abstract][Full Text]
34. Fuhlbrigge AL, Kitch BT, Paltiel AD, et al. FEV(1) is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol. 2001 Jan;107(1):61-7.[Abstract][Full Text]
35. Kwon JW, Jung H, Kim SH, et al. High ACT score is not sufficient to reduce the risk of asthma exacerbations in asthma with low lung function. Respir Med. 2019 Apr;150:38-44.[Abstract][Full Text]
36. Pongracic JA, Krouse RZ, Babineau DC, et al. Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents. J Allergy Clin Immunol. 2016 Oct;138(4):1030-1041.[Abstract][Full Text]
37. Hernandez-Ramirez G, Barber D, Tome-Amat J, et al. Alternaria as an inducer of allergic sensitization. J Fungi (Basel). 2021 Oct 7;7(10):838.[Abstract][Full Text]
38. Engelkes M, Janssens HM, de Jongste JC, et al. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015 Feb;45(2):396-407.[Abstract][Full Text]
39. British Thoracic Society/Scottish Intercollegiate Guidelines Network. SIGN 158: British guideline on the management of asthma. A national clinical guideline. Jul 2019 [internet publication].[Full Text]
40. Miller MK, Lee JH, Miller DP, et al. Recent asthma exacerbations: a key predictor of future exacerbations. Respir Med. 2007 Mar;101(3):481-9.[Abstract][Full Text]
41. Altamimi S, Robertson G, Jastaniah W, et al. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care. 2006 Dec;22(12):786-93.[Abstract]
42. Oosterholt S, Pavord ID, Brusselle G, et al. Modelling ASthma TrEatment Responses (MASTER): effect of individual patient characteristics on the risk of exacerbation in moderate or severe asthma: a time-to-event analysis of randomized clinical trials. Br J Clin Pharmacol. 2023 Nov;89(11):3273-90.[Abstract][Full Text]
43. Noble M, Burden A, Stirling S, et al. Predicting asthma-related crisis events using routine electronic healthcare data: a quantitative database analysis study. Br J Gen Pract. 2021 Dec;71(713):e948-57.[Abstract][Full Text]
44. McLeish AC, Zvolensky MJ. Asthma and cigarette smoking: a review of the empirical literature. J Asthma. 2010 May;47(4):345-61.[Abstract][Full Text]
45. Thien F. Asthma: its phenotypes and the influences of analgesics. Aust J Pharmacy. 2007;88:76-80.
46. Centers for Disease Control and Prevention. Risk factors. 2016 [Internet publication].[Full Text]
47. Bancroft GJ, Schreiber RD, Unanue ER. T cell-independent macrophage activation in scid mice. Curr Top Microbiol Immunol. 1989;152:235-42.[Abstract]
48. National Heart, Lung, and Blood Institute. Guidelines for the diagnosis and management of asthma. Aug 2007 [Internet publication].[Full Text]
49. Harris K, Kneale D, Lasserson TJ, et al. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev. 2019 Jan 28;1(1):CD011651.[Abstract][Full Text]
50. Kew KM, Malik P, Aniruddhan K, et al. Shared decision-making for people with asthma. Cochrane Database Syst Rev. 2017 Oct 3;10(10):CD012330.[Abstract][Full Text]
51. Normansell R, Kew KM, Stovold E. Interventions to improve adherence to inhaled steroids for asthma. Cochrane Database Syst Rev. 2017 Apr 18;4(4):CD012226.[Abstract][Full Text]
52. Chan A, De Simoni A, Wileman V, et al. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database Syst Rev. 2022 Jun 13;6(6):CD013030.[Abstract][Full Text]
53. Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.[Abstract][Full Text]
54. Chen KYH, Saxon L, Robertson C, et al. Reducing asthma hospitalisations in at-risk children: asystematic review. J Paediatr Child Health. 2021 Sep;57(9):1376-84.[Abstract][Full Text]
55. Still L, Dolen WK. The perception of asthma severity in children. Curr Allergy Asthma Rep. 2016 Jul;16(7):50.[Abstract]
56. National Asthma Council. Australian asthma handbook. April 2022 [internet publication]. [Full Text]
57. Chavasse R, Seddon P, Bara A, et al. Short acting beta agonists for recurrent wheeze in children under 2 years of age. Cochrane Database Syst Rev. 2002;(3):CD002873.[Abstract][Full Text]
58. Kelly AM, Kyle E, McAlpine R. Venous pCO(2) and pH can be used to screen for significant hypercarbia in emergency patients with acute respiratory disease. J Emerg Med. 2002 Jan;22(1):15-9.[Abstract]
59. Gorelick MH, Stevens MW, Schultz T, et al. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care. 2004 Jan;20(1):22-6.[Abstract]
60. Turner S, Cotton S, Wood J, et al. Reducing asthma attacks in children using exhaled nitric oxide (RAACENO) as a biomarker to inform treatment strategy: a multicentre, parallel, randomised, controlled, phase 3 trial. Lancet Respir Med. 2022 Jun;10(6):584-92.[Abstract]
61. Centers for Disease Control and Prevention. Best practices for healthcare professionals on the use of polymerase chain reaction (PCR) for diagnosing pertussis. Aug 2022 [Internet publication]. [Full Text]
62. Giddings EH, Carmean SL. Reduced brightness contrast as a reading aid. Percept Mot Skills. 1989 Oct;69(2):383-6.[Abstract]
63. Chang AB, Fortescue R, Grimwood K, et al. Task Force report: European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. 2021 Feb 11;2002990.[Abstract]
64. Saito J, Harris WT, Gelfond J, et al. Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough. Pediatr Pulmonol. 2006 Aug;41(8):709-19.[Abstract]
65. Sunman B, Ademhan Tural D, Ozsezen B, et al. Current approach in the diagnosis and management of allergic bronchopulmonary aspergillosis in children with cystic fibrosis. Front Pediatr. 2020 Oct 20;8:582964.[Abstract][Full Text]
66. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60.[Abstract][Full Text]
67. Trottier ED, Chan K, Allain D, et al. Managing an acute asthma exacerbation in children. Paediatr Child Health. 2021 Nov;26(7):438-9.[Abstract][Full Text]
68. Normansell R, Sayer B, Waterson S, et al. Antibiotics for exacerbations of asthma. Cochrane Database Syst Rev. 2018 Jun 25;(6):CD002741.[Abstract][Full Text]
69. Leatherman J. Mechanical ventilation for severe asthma. Chest. 2015 Jun;147(6):1671-80.[Abstract]
70. Schuh S, Sweeney J, Rumantir M, et al. Effect of nebulized magnesium vs placebo added to albuterol on hospitalization among children with refractory acute asthma treated in the emergency department: a randomized clinical trial. JAMA. 2020 Nov 24;324(20):2038-47.[Abstract]
71. Su Z, Li R, Gai Z. Intravenous and nebulized magnesium sulfate for treating acute asthma in children: a systematic review and meta-analysis. Pediatr Emerg Care. 2018 Jun;34(6):390-5.[Abstract]
72. Cheuk DK, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child. 2005 Jan;90(1):74-7.[Abstract][Full Text]
73. Rowe BH, Bretzlaff JA, Bourdon C, et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med. 2000 Sep;36(3):181-90.[Abstract]
74. Powell C, Kolamunnage-Dona R, Lowe J, et al. Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial. Lancet Respir Med. 2013 Jun;1(4):301-8.[Abstract]
75. Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017 Nov 28;11:CD003898.[Abstract][Full Text]
76. Alansari, Ahmed W, Davidson BL, et al. Nebulized magnesium for moderate and severe pediatric asthma: a randomized trial. Pediatr Pulmonol. 2015 Dec;50(12):1191-9.[Full Text]
77. Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013 Sep 13;(9):CD000052.[Abstract][Full Text]
78. Rowe BH, Spooner C, Ducharme FM, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001 Jan 22;(1):CD002178.[Abstract][Full Text]
79. Griffiths B, Ducharme FM. Combined inhaled anticholinergics and short-acting beta2-agonists for initial treatment of acute asthma in children. Cochrane Database Syst Rev. 2013 Aug 21;(8):CD000060.[Abstract][Full Text]
80. Craig SS, Dalziel SR, Powell CV, et al. Interventions for escalation of therapy for acute exacerbations of asthma in children: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2020 Aug 5;(8):CD012977.[Abstract][Full Text]
81. Sears MR. Inhaled beta agonists. Ann Allergy. 1992 May;68(5):446.[Abstract]
82. Everard ML, Bara A, Kurian M, et al. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001279.[Abstract][Full Text]
83. Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists for acute asthma. Cochrane Database Syst Rev. 2003 Oct 23;(4):CD001115.[Abstract][Full Text]
84. Kulalert P, Phinyo P, Patumanond J, et al. Continuous versus intermittent short-acting beta2-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis. Asthma Res Pract. 2020 Jul 2;6:6.[Abstract][Full Text]
85. Jackson DJ, Bacharier LB, Mauger DT, et al. Quintupling inhaled glucocorticoids to prevent childhood asthma exacerbations. N Engl J Med. 2018 Mar 8;378(10):891-901.[Abstract][Full Text]
86. Hendeles L, Sherman J. Are inhaled corticosteroids effective for acute exacerbations of asthma in children? J Pediatr. 2003 Feb;142(2 Suppl):S26-32.[Abstract]
87. Kew KM, Flemyng E, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2022 Sep 26;9(9):CD007524.[Abstract][Full Text]
88. Garrett J, Williams S, Wong C, et al. Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid. Arch Dis Child. 1998 Jul;79(1):12-7.[Abstract][Full Text]
89. Hasegawa K, Craig SS, Teach SJ, et al. Management of asthma exacerbations in the emergency department. J Allergy Clin Immunol Pract. 2020 Dec 31 [Epub ahead of print].[Abstract]
90. Edmonds ML, Milan SJ, Camargo-Jr CA, et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD002308.[Abstract][Full Text]
91. Kearns N, Maijers I, Harper J, et al. Inhaled corticosteroids in acute asthma: a systemic review and meta-analysis. J Allergy Clin Immunol Pract. 2020 Feb;8(2):605-17.e6.[Abstract]
92. Dahan E, El Ghazal N, Nakanishi H, et al. Dexamethasone versus prednisone/prednisolone in the management of pediatric patients with acute asthmatic exacerbations: a systematic review and meta-analysis. J Asthma. 2023 Aug;60(8):1481-92.[Abstract]
93. Kirkland SW, Cross E, Campbell S, et al. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. Cochrane Database Syst Rev. 2018 Jun 2;6(6):CD012629.[Abstract][Full Text]
94. Langton Hewer S, Hobbs J, Reid F, et al. Prednisolone in acute childhood asthma: clinical responses to three dosages. Respir Med. 1998 Mar;92(3):541-6.[Abstract]
95. Buddala PK, Chandrasekaran V, Harichandrakumar KT. A 3-day course of 1 mg/kg versus 2 mg/kg bodyweight prednisolone for 1- to 5-year-old children with acute moderate exacerbation of asthma: a randomized double-blind noninferiority trial. Paediatr Child Health. 2021 Jul;26(4):e189-93.[Abstract][Full Text]
96. Normansell R, Kew KM, Mansour G. Different oral corticosteroid regimens for acute asthma. Cochrane Database Syst Rev. 2016 May 13;(5):CD011801.[Abstract][Full Text]
97. Yao TC, Wang JY, Chang SM, et al. Association of oral corticosteroid bursts with severe adverse events in children. JAMA Pediatr. 2021 Jul 1;175(7):723-9.[Abstract][Full Text]
98. Hendeles L. Selecting a systemic corticosteroid for acute asthma in young children. J Pediatr. 2003 Feb;142(2 Suppl):S40-4.[Abstract]
99. Price D, Castro M, Bourdin A, et al. Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety. Eur Respir Rev. 2020 Apr 3;29(155):190151.[Abstract][Full Text]
100. Bleecker ER, Al-Ahmad M, Bjermer L, et al. Systemic corticosteroids in asthma: a call to action from World Allergy Organization and Respiratory Effectiveness Group. World Allergy Organ J. 2022 Dec;15(12):100726.[Abstract][Full Text]
101. Chang AB, Clark R, Sloots TP, et al. A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial. Med J Aust. 2008 Sep 15;189(6):306-10.[Abstract]
102. Storr J, Barrell E, Barry W, et al. Effect of a single oral dose of prednisolone in acute childhood asthma. Lancet. 1987 Apr 18;1(8538):879-82.[Abstract]
103. Ho L, Landau LI, Le Souef PN. Lack of efficacy of single-dose prednisolone in moderately severe asthma. Med J Aust. 1994 Jun 6;160(11):701-4.[Abstract]
104. Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev. 2016 Apr 29;4(4):CD011050.[Abstract][Full Text]
105. Pruikkonen H, Tapiainen T, Kallio M, et al. Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial. Eur Respir J. 2018 Feb 7;51(2):1701579.[Abstract][Full Text]
106. Roberts G, Newsom D, Gomez K, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Thorax. 2003 Apr;58(4):306-10.[Abstract][Full Text]
107. Kirby C. Comparison of intravenous and inhaled salbutamol in severe acute asthma. Pediatr Rev Commun. 1988;3:67-77.
108. Browne GJ, Penna AS, Phung X, et al. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet. 1997 Feb 1;349(9048):301-5.[Abstract]
109. Browne GJ, Lam LT. Single-dose intravenous salbutamol bolus for managing children with acute severe asthma in the emergency department: reanalysis of data. Pediatr Crit Care Med. 2002 Apr;3(2):117-23.[Abstract]
110. Travers A, Jones AP, Kelly K, et al. Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev. 2001 Jan 22:(1):CD002988.[Abstract][Full Text]
111. Nair P, Milan SJ, Rowe BH. Addition of intravenous aminophylline to inhaled beta(2)-agonists in adults with acute asthma. Cochrane Database Syst Rev. 2012 Dec 12;12(12):CD002742.[Abstract][Full Text]
112. Travers AH, Jones AP, Camargo CA Jr, et al. Intravenous beta(2)-agonists versus intravenous aminophylline for acute asthma. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD010256.[Abstract][Full Text]
113. Baggott C, Hardy JK, Sparks J, et al. Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis. Thorax. 2022 Jun;77(6):563-72.[Abstract]
114. Schramm CM, Carroll CL. Advances in treating acute asthma exacerbations in children. Curr Opin Pediatr. 2009 Jun;21(3):326-32.[Abstract]
115. Baudin F, Buisson A, Vanel B, et al. Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Ann Intensive Care. 2017 Dec;7(1):55.[Abstract][Full Text]
116. Russi BW, Lew A, McKinley SD, et al. High-flow nasal cannula and bilevel positive airway pressure for pediatric status asthmaticus: a single center, retrospective descriptive and comparative cohort study. J Asthma. 2022 Apr;59(4):757-64.[Abstract]
117. Gates RM, Haynes KE, Rehder KJ, et al. High-flow nasal cannula in pediatric critical asthma. Respir Care. 2021 Aug;66(8):1240-6.[Abstract][Full Text]
118. Korang SK, Feinberg J, Wetterslev J, et al. Non-invasive positive pressure ventilation for acute asthma in children. Cochrane Database Syst Rev. 2016 Sep 30;(9):CD012067.[Abstract][Full Text]
119. Rodrigo G, Pollack C, Rodrigo C, et al. Heliox for nonintubated acute asthma patients. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD002884.[Abstract][Full Text]
120. Kim IK, Phrampus E, Venkataraman S, et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: a randomized, controlled trial. Pediatrics. 2005 Nov;116(5):1127-33.[Abstract]
121. Camargo CA Jr, Smithline HA, Malice MP, et al. A randomized controlled trial of intravenous montelukast in acute asthma. Am J Respir Crit Care Med. 2003 Feb 15;167(4):528-33.[Abstract][Full Text]
122. Watts K, Chavasse RJ. Leukotriene receptor antagonists in addition to usual care for acute asthma in adults and children. Cochrane Database Syst Rev. 2012 May 16;(5):CD006100.[Abstract][Full Text]
123. Adachi M, Taniguchi H, Tohda Y, et al. The efficacy and tolerability of intravenous montelukast in acute asthma exacerbations in Japanese patients. J Asthma. 2012 Aug;49(6):649-56.[Abstract]
124. Morris CR, Becker AB, Piñieiro A, et al. A randomized, placebo-controlled study of intravenous montelukast in children with acute asthma. Ann Allergy Asthma Immunol. 2010 Feb;104(2):161-71.[Abstract]
125. Food and Drug Administration. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. Mar 2020 [internet publication].[Full Text]
126. Rodrigo GJ, Neffen H, Colodenco FD, et al. Formoterol for acute asthma in the emergency department: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2010 Mar;104(3):247-52.[Abstract]
127. Bussamra MH, Stelmach R, Rodrigues JC, et al. A randomized, comparative study of formoterol and terbutaline dry powder inhalers in the treatment of mild to moderate asthma exacerbations in the pediatric acute care setting. Ann Allergy Asthma Immunol. 2009 Sep;103(3):248-53.[Abstract]
128. Arun JJ, Lodha R, Kabra SK. Bronchodilatory effect of inhaled budesonide/formoterol and budesonide/salbutamol in acute asthma: a double-blind, randomized controlled trial. BMC Pediatr. 2012 Mar 7;12:21.[Abstract][Full Text]
129. Stefanidis C, Martineau AR, Nwokoro C, et al. Vitamin D for secondary prevention of acute wheeze attacks in preschool and school-age children. Thorax. 2019 Oct;74(10):977-85.[Abstract]
130. Williamson A, Martineau AR, Sheikh A, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev. 2023 Feb 6;2(2):CD011511.[Abstract][Full Text]
131. The Royal Children's Hospital Melbourne. Acute asthma. 2023 [internet publication].[Full Text]
132. Centers for Disease Control and Prevention. Most recent asthma data. Dec 2022 [internet publication].[Full Text]
133. Mukherjee M, Cunningham S, Bhuia MR, et al. Asthma in paediatric intensive care in England residents: observational study. Sci Rep. 2022 Jan 25;12(1):1315.[Abstract][Full Text]
134. Bergstrom SE, Boman G, Eriksson L, et al. Asthma mortality among Swedish children and young adults, a 10-year study. Respir Med. 2008 Sep;102(9):1335-41.[Abstract]
135. Roberts G, Patel N, Levi-Schaffer F, et al. Food allergy as a risk factor for life-threatening asthma in childhood: a case-controlled study. J Allergy Clin Immunol. 2003 Jul;112(1):168-74.[Abstract]
136. O'Byrne PM, Pedersen S, Lamm CJ, et al. START Investigators Group. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009 Jan 1;179(1):19-24.[Abstract]
137. Stack AM, Caputo GL. Pneumomediastinum in childhood asthma. Pediatr Emerg Care. 1996 Apr;12(2):98-101.[Abstract]
138. Kravis LP. An analysis of fifteen childhood asthma fatalities. J Allergy Clin Immunol. 1987 Sep;80(3 Pt 2):467-72.[Abstract]
139. Meduri GU, Cook TR, Turner RE, et al. Noninvasive positive pressure ventilation in status asthmaticus. Chest. 1996 Sep;110(3):767-74.[Abstract]
140. Edmonds ML, Milan SJ, Brenner BE, et al. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database Syst Rev. 2012 Dec 12;(12):CD002316.[Abstract][Full Text]
141. Hall KK, Petsky HL, Chang AB, et al. Caseworker-assigned discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness. Cochrane Database Syst Rev. 2018 Nov 2;(11):CD012315.[Abstract][Full Text]
142. Chan M, Gray M, Burns C, et al. Assessment of variation in care following hospital discharge for children with acute asthma. J Asthma Allergy. 2021;14:797-808.[Abstract][Full Text]
143. Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009 Jan;43(1):85-97.[Abstract]
144. McCallum GB, Morris PS, Brown N, et al. Culture-specific programs for children and adults from minority groups who have asthma. Cochrane Database Syst Rev. 2017 Aug 22;(8):CD006580.[Abstract][Full Text]
145. Wolf FM, Guevara JP, Grum CM, et al. Educational interventions for asthma in children. Cochrane Database Syst Rev. 2002 Oct 21;(4):CD000326.[Abstract][Full Text]
146. Ducharme FM, Zemek RL, Chalut D, et al. Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control. Am J Respir Crit Care Med. 2011 Jan 15;183(2):195-203.[Abstract][Full Text]
147. Cano-Garcinuno A, Diaz-Vazquez C, Carvajal-Uruena I, et al. Group education on asthma for children and caregivers: a randomized, controlled trial addressing effects on morbidity and quality of life. J Investig Allergol Clin Immunol. 2007;17(4):216-26.[Abstract]
148. Zemek RL, Bhogal SK, Ducharme FM. Systematic review of randomized controlled trials examining written action plans in children: what is the plan? Arch Pediatr Adolesc Med. 2008 Feb;162(2):157-63.[Abstract][Full Text]
149. Chang AB, Taylor B, Masters IB, et al. Indigenous healthcare worker involvement for indigenous adults and children with asthma. Cochrane Database Syst Rev. 2010 May 12;(5):CD006344.[Abstract][Full Text]
150. Flores G, Bridon C, Torres S, et al. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics. 2009 Dec;124(6):1522-32.[Abstract]
151. Vuillermin P, South M, Robertson C. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD005311.[Abstract][Full Text]
152. Ganaie MB, Munavvar M, Gordon M, et al. Patient- and parent-initiated oral steroids for asthma exacerbations. Cochrane Database Syst Rev. 2016 Dec 12;12(12):CD012195.[Abstract][Full Text]
153. Boyd M, Lasserson TJ, McKean MC, et al. Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD001290.[Abstract][Full Text]
154. Bravata DM, Gienger AL, Holty JE, et al. Quality improvement strategies for children with asthma: a systematic review. Arch Pediatr Adolesc Med. 2009 Jun;163(6):572-81.[Abstract][Full Text]
155. Coffman JM, Cabana MD, Halpin HA, et al. Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics. 2008 Mar;121(3):575-86.[Abstract]
156. Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008 Apr;102(4):593-604.[Abstract]
157. Safety update on home use of nebulisers for acute asthma treatment in children. Drug Ther Bull. 2022 Dec;60(12):180.[Abstract]
158. Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD000364.[Abstract][Full Text]
159. Pedroza A, Huerta JG, Garcia Mde L, et al. The safety and immunogenicity of influenza vaccine in children with asthma in Mexico. Int J Infect Dis. 2009 Jul;13(4):469-75.[Abstract]
160. Sheikh A, Alves B, Dhami S. Pneumococcal vaccine for asthma. Cochrane Database Syst Rev. 2002 Jan 21;(1):CD002165.[Abstract][Full Text]
161. Brożek JL, Bousquet J, Agache I, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017 Oct;140(4):950-8. [Abstract][Full Text]
162. Teoh L, Mackay IM, Van Asperen PP, et al. Presence of atopy increases the risk of asthma relapse. Arch Dis Child. 2018 Apr;103(4):346-51.[Abstract]
163. Wilson SR, Farber HJ, Knowles SB, et al. A randomized trial of parental behavioral counseling and cotinine feedback for lowering environmental tobacco smoke exposure in children with asthma: results of the LET'S Manage Asthma trial. Chest. 2011 Mar;139(3):581-90.[Abstract]
164. Mackay DF, Turner SW, Semple SE, et al. Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data. Lancet Public Health. 2021 Aug;6(8):e579-86.[Abstract][Full Text]
165. Rowe BH, Spooner CH, Ducharme FM, et al. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000195.[Abstract][Full Text]