A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children

  title={A review of the use of adjunctive therapies in severe acute asthma exacerbation in critically ill children},
  author={Judith Ju-Ming Wong and Jan Hau Lee and David A. Turner and Kyle J. Rehder},
  journal={Expert Review of Respiratory Medicine},
  pages={423 - 441}
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… 

Adjunct Therapies for Refractory Status Asthmaticus in Children

A review will present the physiologic basis and supporting data for a host of adjunct therapies, including ipratropium, intravenous β agonists, methylxanthines, intravenously and inhaled magnesium, heliox (helium-oxygen mixture), ketamine, antibiotics, noninvasive ventilation, inhaled anesthetics, and extracorporeal membrane oxygenation.

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

  • J. Tennyson
  • Medicine
    Current Emergency and Hospital Medicine Reports
  • 2015
Parenteral beta-adrenergic medications have a long history of use, but have not been consistently shown to be superior to inhaled short-acting beta agonists, and have been associated with higher rates of adverse effects.

Management of Acute Asthma in Children

Practical evidence-based pathways and a stepwise approach are provided for management of acute asthma in the home, outpatient, emergency, and intensive care settings and popular myths are dispelled.

Refractory Status Asthmaticus: A Case for Unconventional Therapies

This work presents successful use of Extracorporeal Membrane Oxygenation and isoflurane in a child with Refractory Status Asthmaticus.

A Contemporary Approach to the Treatment of Perioperative Bronchospasm

The diagnosis of bronchospasm is reviewed and the contemporary treatment methods that should be employed to prevent bron chospasm-related morbidity and mortality during the perioperative period are reviewed.

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

This Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2, and should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to β2 agonists.

High flow nasal cannula oxygen therapy in patients with asthmatic crisis in the pediatric emergency department.

The incorporation of HFNC oxygen therapy in the treatment of patients with asthmatic crises in the Pediatric Emergency Department did not show clinical benefits nor did it diminish the stay time.

Enoximone in status asthmaticus

In a patient with severe status asthmaticus, enoximone, a phosphodiesterase-3 inhibitor, caused immediate bronchodilation, and extracorporeal membrane oxygenation (ECMO) support is nowadays an established treatment option as a bridge to recovery.

Extracorporeal Carbon Dioxide Removal for the Exacerbation of Chronic Hypercapnic Respiratory Diseases

This review will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO 2 R in patients with severe exacerbations of these pathologies and potentially prevent, shorten the duration of invasive mechanical ventilation.

Magnesium Treatment in Pediatric Patients.

  • Sarah AndersonE. Farrington
  • Medicine
    Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners
  • 2021



Ketamine for management of acute exacerbations of asthma in children.

The single study on non-intubated children with severe acute asthma did not show significant benefit and does not support the case studies and observational reports showing benefits of ketamine, and there is need for sufficiently powered randomised trials of high methodological quality with objective outcome measures of clinical importance.

Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy

Ketamine should only be used for asthmatics whose respiratory failure does not respond to conventional management and mechanical ventilation, and except for increased secretions during the infusion, patients showed no immediate or long-term sequelae from ketamine therapy.

Inhalational anesthetics in acute severe asthma.

A brief description of the physio-pathological and clinical features of acute severe asthma, and of the principles of treatment is provided, focusing on the use of the inhalational anesthetics in severe patients requiring mechanical ventilation and not responding to conventional therapy.

Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy.

Severe asthmatic cases may benefit from magnesium sulphate therapy when beta-2 agonists are inadequate in preventing deterioration, according to this randomized, double-blind, placebo-controlled clinical trial.

Isoflurane therapy for severe refractory status asthmaticus in children

Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management.

Inhaled magnesium sulfate in the treatment of acute asthma.

Nebulised inhaled magnesium sulfate in addition to beta2-agonist in the treatment of an acute asthma exacerbation, appears to have benefits with respect to improved pulmonary function and there is a trend towards benefit in hospital admission.

Gas exchange response to intravenous aminophylline in patients with a severe exacerbation of asthma.

In patients with acute exacerbations of asthma, the intravenous administration of bronchodilators, such as salbutamol, entails the potential risk of worsening pulmonary gas exchange, despite an

Intravenous beta(2)-agonists versus intravenous aminophylline for acute asthma.

The benefit of IV beta(2)-agonists versus IV aminophylline for acute asthma treated in the emergency department and in patients admitted to hospital with acute severe asthma is compared.

Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators.

In children with a severe asthma exacerbation, the addition of intravenous aminophylline to beta2-agonists and glucocorticoids (with or without anticholinergics) improves lung function within 6 hours of treatment, however there is no apparent reduction in symptoms, number of nebulised treatment and length of hospital stay.

Extracorporeal life support for status asthmaticus: the breath of life that's often forgotten

The use of ECLS for status asthmaticus, as reported through the Extracorporeal Life Support Organization, is briefly overviewed, including the specific institutional experience at Children's Healthcare of Atlanta at Egleston, and how earlier initiation of EFLS may benefit patients with severe status ast hmaticus refractory to conventional medical therapy is considered.