Acute asthma exacerbation (peds) - Revision history

Danbot: Add MedicationDose entries (albuterol, ipratropium, dexamethasone, prednisone, magnesium) with SMW annotations

2026-03-20T19:00:46Z

Add MedicationDose entries (albuterol, ipratropium, dexamethasone, prednisone, magnesium) with SMW annotations

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 *[[Theophylline]], leukotriene antagonist, or PO [[prednisolone]] with taper
 |}
 ==Disposition==

Ostermayer at 17:35, 17 January 2026

2026-01-17T17:35:03Z

← Older revision		Revision as of 17:35, 17 January 2026
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	{{~~Peds top~~}} ~~[[asthma]]~~		{{PediatricPage\|asthma}}
	==Background==		==Background==
	[[File:Asthma attack-illustration NIH.jpg\|thumb\|Comparison of normal airway (B) to airway during asthma symptoms (C).]]		[[File:Asthma attack-illustration NIH.jpg\|thumb\|Comparison of normal airway (B) to airway during asthma symptoms (C).]]

Rossdonaldson1: /* Consider CXR */

2025-08-13T20:12:01Z

Consider CXR

← Older revision		Revision as of 20:12, 13 August 2025
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	*Fever not explained by apparent viral illness		*Fever not explained by apparent viral illness

	''Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard practice.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.</ref>''		''Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common,<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref> however is no longer considered standard practice.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.</ref>''

	===Clinical Scores===		===Clinical Scores===

Rossdonaldson1: /* Consider CXR */

2025-08-13T20:11:24Z

Consider CXR

← Older revision		Revision as of 20:11, 13 August 2025
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	*Fever not explained by apparent viral illness		*Fever not explained by apparent viral illness

	Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard practice.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.</ref>		''Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard practice.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.</ref>''

	===Clinical Scores===		===Clinical Scores===

Rossdonaldson1: /* Consider CXR */

2025-08-13T20:10:49Z

Consider CXR

← Older revision		Revision as of 20:10, 13 August 2025
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	*Fever not explained by apparent viral illness		*Fever not explained by apparent viral illness

	Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard ~~process~~.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.		Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard practice.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.</ref>

	===Clinical Scores===		===Clinical Scores===

Rossdonaldson1: /* Consider CXR */

2025-08-13T20:10:24Z

Consider CXR

← Older revision		Revision as of 20:10, 13 August 2025
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	===Consider [[CXR]]===		===Consider [[CXR]]===
	*1st wheezing episode
	*Asymmetric lung auscultation findings, after treatment with albuterol		*Asymmetric lung auscultation findings, after treatment with albuterol
	*Poor response to medications/treatment, if history and exam are not consistent with [[bronchiolitis]]		*Poor response to medications/treatment, if history and exam are not consistent with [[bronchiolitis]]
	*Worsening symptoms		*Worsening symptoms
	*Fever not explained by apparent viral illness		*Fever not explained by apparent viral illness

			Obtaining a [[CXR]] in pediatric patients presenting with their first episode of wheezing was previously common<ref>Patel NH, et al. The Practice of Obtaining a Chest X-Ray in Pediatric Patients Presenting With Their First Episode of Wheezing in the Emergency Department - A Survey of Attending Physicians. Pediatric Emergency Care 36(1):p 16-20, January 2020. \| DOI: 10.1097/PEC.0000000000002015</ref>, however is no longer considered a standard process.<ref>Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics (2014) 134 (5): e1474–e1502. https://doi.org/10.1542/peds.2014-2742.

	===Clinical Scores===		===Clinical Scores===

Rossdonaldson1: /* Background */

2024-04-24T16:07:30Z

Background

← Older revision		Revision as of 16:07, 24 April 2024
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	{{Peds top}} [[asthma]]		{{Peds top}} [[asthma]]
	==Background==		==Background==
			[[File:Asthma attack-illustration NIH.jpg\|thumb\|Comparison of normal airway (B) to airway during asthma symptoms (C).]]
			[[File:Features of airway remodeling in asthma.jpg\|thumb\|Features of remodeling in asthma.]]
	*An estimated 6 million children in the US have asthma		*An estimated 6 million children in the US have asthma
	*In 2007, asthma lead to >700,000 ED visits		*In 2007, asthma lead to >700,000 ED visits

Rossdonaldson1: /* Outpatient Treatment */

2023-02-01T18:13:24Z

Outpatient Treatment

← Older revision		Revision as of 18:13, 1 February 2023
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	\| align="center" style="background:*f0f0f0;"\|'''Treatment (WHO 2008 Formulary)<ref>Stuart MC et al. WHO Model Formulary 2008. http://www.who.int/selection_medicines/list/WMF2008.pdf.</ref>'''		\| align="center" style="background:*f0f0f0;"\|'''Treatment (WHO 2008 Formulary)<ref>Stuart MC et al. WHO Model Formulary 2008. http://www.who.int/selection_medicines/list/WMF2008.pdf.</ref>'''
	\|-		\|-
	\| Mild intermittent, > 80% peak flow\|\|< 2/wk\|\|< 2/mo\|\|[[Albuterol]] MDI 100-200 mcg PRN QID		\| Mild intermittent, > 80% peak flow\|\|< 2/wk\|\|< 2/mo\|\|
			*[[Albuterol]] MDI 100-200 mcg PRN QID
	\|-		\|-
	\| Mild persistent, > 80% peak flow\|\|>2/wk\|\|>2/mo\|\|[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''		\| Mild persistent, > 80% peak flow\|\|>2/wk\|\|>2/mo\|\|
	[[Beclometasone]] 100-250 mcg BID		*[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''
			*[[Beclometasone]] 100-250 mcg BID
	\|-		\|-
	\| Moderate persistent, 60-80% peak flow\|\|Daily with exacerbations weekly\|\|> 1/wk\|\|[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''		\| Moderate persistent, 60-80% peak flow\|\|Daily with exacerbations weekly\|\|> 1/wk\|\|
	[[Beclometasone]] 100-500 mcg BID '''AND'''		*[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''
			*[[Beclometasone]] 100-500 mcg BID '''AND'''
	[[Salmeterol]] inhaled 50 mcg BID		*[[Salmeterol]] inhaled 50 mcg BID
	\|-		\|-
	\| Severe persistent, < 60% peak flow\|\|Continuous daily\|\|Frequent\|\|[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''		\| Severe persistent, < 60% peak flow\|\|Continuous daily\|\|Frequent\|\|
	[[Beclometasone]] 1mg BID (high dose) '''AND'''		*[[Albuterol]] MDI 100-200 mcg PRN QID '''AND'''
			*[[Beclometasone]] 1mg BID (high dose) '''AND'''
	[[Salmeterol]] inhaled 50 mcg BID '''AND'''		*[[Salmeterol]] inhaled 50 mcg BID '''AND'''
			*[[Theophylline]], leukotriene antagonist, or PO [[prednisolone]] with taper
	[[~~theophylline~~]], leukotriene antagonist, or PO [[prednisolone]] with taper
	\|}		\|}

Cdichang: /* Background */

2022-08-04T19:36:49Z

Background

← Older revision		Revision as of 19:36, 4 August 2022
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	*A history of eczema or allergies maybe helpful in making a new diagnosis of asthma		*A history of eczema or allergies maybe helpful in making a new diagnosis of asthma
	*Wheezing in an infant is more often [[bronchiolitis]] than asthma		*Wheezing in an infant is more often [[bronchiolitis]] than asthma
	*Viral [[URI]] associated with copious ~~rhinorrea~~, allergen exposure, and respiratory irritants (i.e. smoke) are common precipitants for pediatric asthma exacerbations		*Viral [[URI]] associated with copious rhinorrhea, allergen exposure, and respiratory irritants (i.e. smoke) are common precipitants for pediatric asthma exacerbations

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Steroids */

2022-05-03T21:26:08Z

Steroids

← Older revision		Revision as of 21:26, 3 May 2022
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	''Should be given in the first hour with effects to reduce admission<ref name="Rowe">Rowe BH et al. Magnesium sulfate for treating exac- erbations of acute asthma in the emergency depart- ment. Cochrane Database Syst Rev. 2000;(2):CD001490. PMID: 10796650.</ref>''		''Should be given in the first hour with effects to reduce admission<ref name="Rowe">Rowe BH et al. Magnesium sulfate for treating exac- erbations of acute asthma in the emergency depart- ment. Cochrane Database Syst Rev. 2000;(2):CD001490. PMID: 10796650.</ref>''
	*[[Dexamethasone]]		*[[Dexamethasone]]
	**0.~~3mg~~/kg PO or IV (max ~~1mg~~); ~~give~~ 2nd dose 24-36hrs later.		**0.6 mg/kg PO or IV (max 16 mg); consider 2nd dose 24-36hrs later.<ref>Cross KP, et al. Single-dose dexamethasone for mild-to-moderate asthma exacerbations. Can Fam Physician. 2011 Oct; 57(10): 1134–1136.</ref><ref>Shenoi RP, Timm N; Committee on Drugs; Committee on Pediatric Emergency Medicine. Drugs used to treat pediatric emergencies. Pediatrics. 2020;145(1):e20193450. [PubMed 31871244]</ref><ref>Dexamethasone versus prednisone for children receiving asthma treatment in the paediatric inpatient population: protocol for a feasibility randomised controlled trial. BMJ Open. http://dx.doi.org/10.1136/bmjopen-2018-025630</ref>
	***PO and IV have equal efficacy. Giving the IV form by mouth is typically better tolerated by young children (same dosing)		***PO and IV have equal efficacy. Giving the IV form by mouth is typically better tolerated by young children (same dosing)
	**Both 1 and 2 dose regimens as effective as [[prednisone]] or [[prednisolone]] in children <ref>Keeney, et al. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis. Pediatrics. 2013-2273</ref><ref>Cronin et al. "A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department." Annals of EM. May 2016. 67(5):593-601</ref>		**Both 1 and 2 dose regimens as effective as [[prednisone]] or [[prednisolone]] in children <ref>Keeney, et al. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis. Pediatrics. 2013-2273</ref><ref>Cronin et al. "A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department." Annals of EM. May 2016. 67(5):593-601</ref>