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Rashmi Ranjan Das, MD Department of Pediatrics All India Institute of Medical Sciences (AIIMS) New Delhi-110029, INDIA Tel: 91-9013074707 Fax: 91-11-26588641 Email: [email protected]
References
1 Wa n g X F, H o n g J G . M a n a g e m e n t o f s e v e r e a s t h m a exacerbation in children. World J Pediatr 2011;7:293-301. 2 Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. Cochrane Database Syst Rev 2003;(4):CD001115. 3 British Thoracic Society Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. Thorax 2008;63 Suppl 4:iv1-121. 4 Rowe BH, Spooner CH, Ducharme FM, Bretzlaff JA, Bota GW. Corticosteroids for preventing relapse following acute exacerbations of asthma. Cochrane Database Syst Rev 2007;(3):CD000195. 5 Chang AB, Clark R, Sloots TP, Stone DG, Petsky HL, Thearle D, et al. A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial. Med J Aust 2008;189:306-310. 6 Stephanopoulos DE, Monge R, Schell KH, Wyckoff P, Peterson BM. Continuous intravenous terbutaline for pediatric status asthmaticus. Crit Care Med 1998;26:1744-1748. 7 Kambalapalli M, Nichani S, Upadhyayula S. Safety of intravenous terbutaline in acute severe asthma: a retrospective study. Acta Paediatr 2005;94:1214-1217. 8 Wheeler DS, Jacobs BR, Kenreigh CA, Bean JA, Hutson TK, Brilli RJ. Theophylline versus terbutaline in treating critically ill children with status asthmaticus: a prospective, randomized, controlled trial. Pediatr Crit Care Med 2005;6:142-147. doi: 10.1007/s12519-012-0341-9
Author reply
W
e thank Dr. Rashmi Ranjan Das for raising some issues for discussion regarding the management of severe asthma exacerbation in children. For acute severe asthma, repetitive or continuous administration of short acting β2-adrenergic bronchodilators (SABAs) is the cornerstone of therapy. In our article, we mentioned continuous or intermittent administration of SABAs. But a study of intermittent versus continuous nebulized SABAs in severe asthmatic exacerbations provided conflicting results.[1] In clinical practice, intermittent use of SABAs may be more acceptable in most pediatric patients. It provides time for clinical observation and comforting the patients. The current guidelines for management of severe asthmatic exacerbation in children recommend regular inhalation of SABAs. The recommended regimen is 3 doses for every 20 minutes and then every 1-4 hours. [2-4] The systematic use of corticosteroids is recommended for children with severe asthmatic exacerbation. We do agree that oral administration should be considered as a first line treatment just as Dr. Das pointed out. For severe cases, the symptoms such as dyspnea and vomiting may prevent the patients from taking any oral medication.
World J Pediatr, Vol 8 No 1 . February 15, 2012 . www.wjpch.com
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Correspondence
The authors described that, a systematic review failed to identify any significan
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