Management of severe asthma exacerbation in children.
BACKGROUND
Asthma is a common disease in children and acute severe asthma exacerbation can be life-threatening. This article aims to review recent advances in understanding of risk factors, pathophysiology, diagnosis and treatment of severe asthma exacerbation in children.


METHODS
Articles concerning severe asthma exacerbation in children were retrieved from PubMed. Literatures were searched with MeSH words "asthma", "children", "severe asthma exacerbation" and relevant cross references.


RESULTS
Severe asthma exacerbation in children requires aggressive treatments with β2-agonists, anticholinergics, and corticosteroids. Early initiation of inhaled β-agonists and systemic use of steroids are recommended. Other agents such as magnesium and aminophylline have some therapeutic benefits. When intubation and mechanical ventilation are needed, low tidal volume, controlled hypoventilation with lower-than-traditional respiratory rates and permissive hypercapnia can be applied.


CONCLUSIONS
Researchers should continue to detect the risk factors, pathophysiology, diagnosis and treatment of severe asthma exacerbation in children. More studies especially randomized controlled trials are required to evaluate the efficacy and safety of standard and new therapies.
Department of Pediatrics, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China.
Xiao-Fang
XF
Wang
Jian-Guo
JG
Hong
D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000628:Aminophylline / Q000008:administration & dosage; D001249:Asthma / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D002648:Child; D018680:Cholinergic Antagonists / Q000008:administration & dosage; D018450:Disease Progression; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012307:Risk Factors
D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D002121:Calcium Channel Blockers; D018680:Cholinergic Antagonists; D005938:Glucocorticoids; D000628:Aminophylline; D008278:Magnesium Sulfate