title: Acute bronchial asthma.
abstract: Acute asthma is the third commonest cause of pediatric emergency visits at PGIMER. Typically, it presents with acute onset respiratory distress and wheeze in a patient with past or family history of similar episodes. The severity of the acute episode of asthma is judged clinically and categorized as mild, moderate and severe. The initial therapy consists of oxygen, inhaled beta-2 agonists (salbutamol or terbutaline), inhaled budesonide (three doses over 1 h, at 20 min interval) in all and ipratropium bromide and systemic steroids (hydrocortisone or methylprednisolone) in acute severe asthma. Other causes of acute onset wheeze and breathing difficulty such as pneumonia, foreign body, cardiac failure etc. should be ruled out with help of chest radiography and appropriate laboratory investigations in first time wheezers and those not responding to 1 h of inhaled therapy. In case of inadequate response or worsening, intravenous infusion of magnesium sulphate, terbutaline or aminophylline may be used. Magnesium sulphate is the safest and most effective alternative among these. Severe cases may need ICU care and rarely, ventilatory support.
authors.affiliation: Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Grover
authors.forename: Atul
authors.initials: A
authors.lastname: Jindal
authors.forename: Arun
authors.initials: A
authors.lastname: Bansal
authors.forename: Sunit C
authors.initials: SC
authors.lastname: Singhi
mesh_terms: D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000465:Algorithms; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004630:Emergencies; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012140:Respiratory Tract Diseases / Q000175:diagnosis; D012720:Severity of Illness Index; D012985:Software Design; D013224:Status Asthmaticus / Q000175:diagnosis* / Q000188:drug therapy* / Q000628:therapy; D013726:Terbutaline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D018927:Anti-Asthmatic Agents; D019819:Budesonide; D008278:Magnesium Sulfate; D013726:Terbutaline; D000420:Albuterol