According to recent data from the Centers for Disease Control and Prevention, 1 out of 11 children in the United States has asthma. Moreover, 1 of 5 children with asthma presented to the emergency department (ED) for asthma-related care in 2009, and it is the most frequent cause of hospitalization in children in the United States, costing the nation billions of dollars annually.1,2 The symptoms of asthma can vary widely, ranging from mild shortness of breath to fatal status asthmaticus. Timely and targeted intervention during an acute exacerbation can significantly decrease morbidity and mortality. Many emergency clinicians are challenged by managing patients with worsening asthma symptoms and safely determining their disposition. Given the high prevalence of asthma and its potential to progress from mild to moderate to lifethreatening, it is vital for emergency clinicians to have a solid understanding of the management of acute asthma exacerbations.
A literature search was performed in the PubMed database using multiple combinations of the search terms acute asthma exacerbation, pharmacologic man agement, nonpharmacologic management, oninvasive ventilation, invasive mechanical ventilation, innovative asthma treatment, pediatric emergency department, pediatric intensive care, and outcomes. Relevant articles were selected, reviewed, and included in the bibliography. Over 275 articles were reviewed, 244 of which are cited in this article.
Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.
To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study will be included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.