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

• Published in: Expert review of respiratory medicine Vol. 8; no. 4; pp. 423 - 441
• Main Authors: Wong, Judith JM, Lee, Jan Hau, Turner, David A, Rehder, Kyle J
• Format: Journal Article
• Language: English
• Published: England Informa UK, Ltd 01.08.2014; Taylor & Francis; Informa Healthcare
• Subjects: Administration, Inhalation; Adrenergic beta-Agonists - administration & dosage; Adrenergic beta-Agonists - therapeutic use; agonist; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - therapeutic use; Asthma - drug therapy; Asthma - therapy; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - therapeutic use; Child; children; Combined Modality Therapy; critical asthma; Critical Illness; extracorporeal life support; heliox; Humans; inhaled anesthetics; ketamine; magnesium; methylxanthine; pediatric; Respiration, Artificial; status asthmaticus; Treatment Outcome; inhaled anesthetics; children; ketamine; status asthmaticus; critical asthma; extracorporeal life support; magnesium; methylxanthine; heliox; β2-agonist; pediatric
• ISSN: 1747-6348; 1747-6356
• DOI: 10.1586/17476348.2014.915752

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.