Confronting Childhood Asthma: The Acute Challenge скачать в хорошем качестве

Confronting Childhood Asthma: The Acute Challenge

‪@Paediatricbasics‬ Acute asthma is one of the most common respiratory emergencies we encounter in paediatric practice, especially on the wards and in emergency settings. The aim is to keep things simple, systematic, and practical, while also highlighting important learning points and pitfalls through real clinical scenarios. Assessment Comes First The first and most important step in acute asthma management is assessment. 1. ABCD This should not be a one-time assessment. It must be revisited repeatedly throughout management. 2. Assess Severity Alongside ABCD, assess the severity of asthma. According to SIGN 158 guidelines (UK), acute asthma is classified into: mild, moderate and severe. Important Clinical Caveats. Core Management Principles 1. Treat Hypoxia Early 2. Treat Bronchospasm and Inflammation Acute asthma management revolves around: • Bronchodilation • Anti-inflammatory therapy At the same time, always think about: • Possible trigger factors • Differential diagnoses 2. Bronchodilators Salbutamol /Albuterol (β₂-agonist) Salbutamol is the first-line bronchodilator. β₂-agonist work by causing bronchial smooth muscle relaxation Ipratropium Bromide Ipratropium is the second bronchodilator, often used in combination with salbutamol. Mechanism of action: • Acetylcholine receptor antagonist • Reduces cyclic GMP • Different mechanism from salbutamol → synergistic effect Steroids MUST be given early. Options include: • Oral prednisolone (if child can tolerate oral medication) • Dexamethasone • IV hydrocortisone (if oral route not possible) Magnesium Sulphate Magnesium sulphate is an important and interesting medication in acute asthma. I have seen patients dramatically improve with magnesium, although not all respond. Literature shows variable efficacy, but: • Most major guidelines recommend its use in acute severe asthma. Routes: • Nebulised, Intravenous infusion, Both can be used in the same patient Dose: • IV: 40 mg/kg over 20 minutes (maximum 2 g) • Nebulised: 150 mg Side effects to remember: Hypotension, Arrhythmias, Hypermagnesaemia Because of these risks, children receiving magnesium require at least a high-dependency level of monitoring. Key point: If you are at the stage of giving magnesium sulphate, you should already be preparing for aminophylline, as escalation takes time. Aminophylline Aminophylline has been used for many years but has limitations. Important side effects • Hypotension, Arrhythmias, Vomiting, Convulsions It should be used cautiously and with appropriate monitoring. High-Flow Nasal Cannula Oxygen High-flow nasal cannula therapy is increasingly used and likely to become more common. Adrenaline If a child has severe asthma, no response to standard therapies, and no additional help is available, there is no harm in considering adrenaline. Historically: • Adrenaline was one of the main drugs of choice • Used subcutaneously in repeated doses (every 30 minutes) It still has a role in selected, severe cases. The Importance of Reassessment Revisit and reassessment are crucial in all acute management, including asthma. Role of Investigations Investigations have a limited role in acute severe asthma. Blood Tests and Blood Gases • Poor correlation with clinical condition • Use only if clinically indicated or if another diagnosis is suspected Chest X-ray Indicated if: • Severe respiratory distress • Suspected pneumothorax • Suspected infection Learning from Clinical Cases Always reconsider the diagnosis and check for alternative explanations. Key Take-Home Messages • Acute asthma is common but can be deceptive • Always start with ABCD assessment • Treat hypoxia early • Use bronchodilators and steroids promptly • Escalate systematically: magnesium → aminophylline → respiratory support • Investigations have limited but targeted roles • Reassessment is critical • Learn from clinical cases—they are powerful teachers All the information provided is for Educational purpose only. Please follow your respective guidelines.