Peer Reviewed
Feature Article Respiratory medicine
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Minimising the risk of acute asthma in children

Peter Wark, Jodi Hilton
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Abstract

A diagnosis of asthma is important before preventive treatment can be commenced in children after an acute asthma episode. Careful continuing assessment of the severity of the child’s condition is needed to determine the risk of future episodes.

Key Points
  • Acute asthma remains a common and potentially serious problem for children in Australia.
  • In order to manage and prevent acute asthma, a diagnosis of asthma is required and needs to be considered outside the context of the acute event.
  • Acute asthma is a potentially life-threatening event and all children with asthma and their families need to have access to inhaled salbutamol with a holding chamber spacer and know how to use these in the context of acute asthma.
  • A child with acute asthma needs to be closely observed to assess the response to therapy: in those not responding to inhaled bronchodilators, initially consider 'add-on' therapy with inhaled ipratropium bromide and/or intravenous magnesium sulfate.
  • A three-day course of systemic corticosteroids should be considered for all children aged 6 years or older.
  • Systemic corticosteroids are not as effective in children aged 0 to 5 years and should only be used in those with severe acute episodes where hospitalisation is considered.
  • Before discharge from hospital after an acute asthma episode, all patients and their families should: have access to and be able to use inhaled salbutamol in a spacer or holding chamber (with a face mask if appropriate for younger children); be given and know how to follow a written asthma action plan; and have planned follow up with their GP in the community.

    Picture credit: © Seb Oliver/Culture/SPL.