The classification and management of acute asthma in children could feature in both the FRCEM Primary and Intermediate examinations. The tables below summarise the main points from the BTS/SIGN asthma guidelines but you should read around the pharmacology of the following drugs and the pathophysiology of asthma.
Classification of Acute Asthma in Children
This is an easily asked exam question and candidates should have a knowledge of the following criteria.
The nature of treatment required for the management of acute asthma depends on the level of severity, described as follows:
|Life-threatening||Any one of the following in a child with severe asthma:
BTS/SIGN Management of Acute Asthma in Children
All candidates should have a sound knowledge of the BTS and SIGN Asthma Guidelines.
|Oxygen||High-flow oxygen at sufficient rates to achieve SpO2 94 – 98%|
|Ipratropium bromide||250 micrograms/dose mixed with the nebulised β2 agonist solution given every 20 – 30 minutes|
|Intravenous hydrocortisone||4 mg/kg repeated four hourly, reserved for severely affected children who are unable to retain oral medication|
|Nebulised magnesium sulphate||Consider adding 150 mg to each nebulised salbutamol and ipratropium in the first hour in children with a short duration of acute severe asthma symptoms presenting with an SpO2 < 92%|
|Antibiotics||Not given routinely in acute asthma|
|Intravenous aminophylline||Consider a 5 mg/kg loading dose over 20 minutes followed by continuous infusion at 1 mg/kg/hr for children with severe or life-threatening asthma unresponsive to maximal doses of bronchodilators and steroids|
|Intravenous magnesium sulphate||Consider the addition of 40 mg/kg/day as first-line intravenous treatment in children who respond poorly to first-line treatments|