title: A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children.
abstract: Asthma is a common and potentially life threatening childhood condition. Asthma involves not only chronic airway remodeling, but may also include frequent exacerbations resulting from bronchospasm, edema, and mucus production. In children with severe exacerbations, standard therapy with β2-agonists, anti-cholinergic agents, oxygen, and systemic steroids may fail to reverse the severe airflow obstruction and necessitate use of adjunctive therapies. These therapies include intravenous or inhaled magnesium, inhaled helium-oxygen mixtures, intravenous methylxanthines, intravenous β2-agonists, and intravenous ketamine. Rarely, these measures are not successful and following the initiation of invasive mechanical ventilation, inhaled anesthetics or extracorporeal life support may be required. In this review, we discuss the mechanisms and evidence for adjunctive therapies in the setting of severe acute asthma exacerbations in children.
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Judith J M
authors.initials: JJ
authors.lastname: Wong
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000628:therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D016638:Critical Illness; D006801:Humans; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents
keywords: children; critical asthma; extracorporeal life support; heliox; inhaled anesthetics; ketamine; magnesium; methylxanthine; pediatric; status asthmaticus; β2-agonist