Management of acute exacerbation asthma – What’s new?

There is an emphasis in adults and older children on making the diagnosis of asthma before initiation of treatment based on variability in Forced Expiratory Volume in 1second (FEV1) or peak expiratory flow rate (PEFR). Increasingly so, especially in young children, the smaller airways are being recognized as important in asthma and assessment and management of small airway function is developing.

Not all that wheezes is asthma especially in the young child.  However, anti-inflammatory treatment is also important in other common causes of wheeze in the young child. Children less than 5-years-old with intermittent viral wheezing may be treated with intermittent short courses of ICS.

Combination treatment – inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) - as maintenance and reliever therapy (MART) has been advocated and there is a separate track to emphasize superiority over using short-acting beta-agonists (SABA) as reliever. Severe exacerbations, and/or hospital visits and admissions were reduced in combination treatment v.s. single reliever therapy.

Delivery of medication is always important and inhaled therapy has many distinct advantages although there is also a role for oral and parenteral treatment.

Parents and/or the child are the first responders in acute asthma and they need to have a clear plan of action. Asthma action plans should be written (printed, digital and/or pictorial) rather than just verbal.

Finally, the most important step in the management of acute asthma is achieving and maintaining good asthma control.