Acute asthma exacerbation - Revision history

Danbot: Add MedicationDose SMW annotations for asthma medications (13 entries: albuterol, ipratropium, dexamethasone, prednisone, methylprednisolone, magnesium, epinephrine, terbutaline, ketamine); dosing verified per NAEPP EPR-3 and current guidelines

2026-03-20T16:15:57Z

Add MedicationDose SMW annotations for asthma medications (13 entries: albuterol, ipratropium, dexamethasone, prednisone, methylprednisolone, magnesium, epinephrine, terbutaline, ketamine); dosing verified per NAEPP EPR-3 and current guidelines

@@ Línea 259: / Línea 259: @@
 **PEF <40% predicted → should be admitted
 ==See Also==
 *[[Asthma (peds)]]

Ostermayer at 16:26, 15 January 2026

2026-01-15T16:26:59Z

← Revisión anterior		Revisión del 16:26 15 ene 2026
Línea 1:		Línea 1:
	{{~~Adult top}} [[~~asthma (peds)]]		{{AdultPage\|asthma (peds)}}
	==Background==		==Background==
	[[File:Bronchial anatomy with description.png\|thumb\| A - Alveoli		[[File:Bronchial anatomy with description.png\|thumb\| A - Alveoli

Rossdonaldson1: /* Workup */

2025-08-13T20:47:54Z

Workup

← Revisión anterior		Revisión del 20:47 13 ago 2025
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	===Workup===		===Workup===
	*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>		*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>
	**Consider [[CXR]] if:		*Consider [[CXR]] if:
	**Asymmetric lung auscultation findings, after treatment with albuterol		**Asymmetric lung auscultation findings, after treatment with albuterol
	**Poor response to medications/treatment, if history and exam are not consistent with asthma		**Poor response to medications/treatment, if history and exam are not consistent with asthma

Rossdonaldson1: /* Workup */

2025-08-13T20:31:29Z

Workup

← Revisión anterior		Revisión del 20:31 13 ago 2025
Línea 36:		Línea 36:
	===Workup===		===Workup===
	*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>		*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>
	*Consider [[CXR]] if:		**Consider [[CXR]] if:
	*Asymmetric lung auscultation findings, after treatment with albuterol		**Asymmetric lung auscultation findings, after treatment with albuterol
	*Poor response to medications/treatment, if history and exam are not consistent with asthma		**Poor response to medications/treatment, if history and exam are not consistent with asthma
	*Worsening symptoms		**Worsening symptoms
	*Unexplained [[fever]]		**Unexplained [[fever]]
	**[[Chest pain]]		**[[Chest pain]]

Rossdonaldson1: /* Workup */

2025-08-13T20:29:26Z

Workup

← Revisión anterior		Revisión del 20:29 13 ago 2025
Línea 37:		Línea 37:
	*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>		*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>
	*Consider [[CXR]] if:		*Consider [[CXR]] if:
	**[[Fever]] >102.2° F		*Asymmetric lung auscultation findings, after treatment with albuterol
	**Minimal response to ~~at home~~ medications/~~treatments~~		*Poor response to medications/treatment, if history and exam are not consistent with asthma
	**Worsening symptoms		*Worsening symptoms
	**Diffuse expiratory wheezing		*Unexplained [[fever]]
	**Globally diminished breath sounds
	**[[Chest pain]]		**[[Chest pain]]

Rossdonaldson1: /* Workup */

2025-08-13T20:00:36Z

Workup

← Revisión anterior		Revisión del 20:00 13 ago 2025
Línea 35:		Línea 35:
	[[File:CXR3354 IM-1609-1001.png\|thumb\|[[CXR]] with hyperinflated lungs consistent with broncoconstriction.]]		[[File:CXR3354 IM-1609-1001.png\|thumb\|[[CXR]] with hyperinflated lungs consistent with broncoconstriction.]]
	===Workup===		===Workup===
	*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref>		*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref><ref>Sher et al. Int J Crit Care Emerg Med 2022, 8:142</ref>
	*Consider [[CXR]] if:		*Consider [[CXR]] if:
	**[[Fever]] >102.2° F		**[[Fever]] >102.2° F

Rossdonaldson1: /* Workup */

2025-08-13T19:59:16Z

Workup

← Revisión anterior		Revisión del 19:59 13 ago 2025
Línea 35:		Línea 35:
	[[File:CXR3354 IM-1609-1001.png\|thumb\|[[CXR]] with hyperinflated lungs consistent with broncoconstriction.]]		[[File:CXR3354 IM-1609-1001.png\|thumb\|[[CXR]] with hyperinflated lungs consistent with broncoconstriction.]]
	===Workup===		===Workup===
	Consider [[CXR]] if:		*For uncomplicated exacerbations in patients with known asthma, [[CXR]] is ''not'' routinely indicated.<ref>Sakr M, et al. A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations. Pediatr Qual Saf. 2024 Apr 3;9(2):e721. doi: 10.1097/pq9.0000000000000721.</ref>
	*[[Fever]] >102.2° F		*Consider [[CXR]] if:
	*Minimal response to at home medications/treatments		**[[Fever]] >102.2° F
	*Worsening symptoms		**Minimal response to at home medications/treatments
	*Diffuse expiratory wheezing		**Worsening symptoms
	*Globally diminished breath sounds		**Diffuse expiratory wheezing
	*[[Chest pain]]		**Globally diminished breath sounds
			**[[Chest pain]]

	===Diagnosis===		===Diagnosis===

Masoodrm: /* Non-invasive ventilation */

2025-07-21T17:04:34Z

Non-invasive ventilation

← Revisión anterior		Revisión del 17:04 21 jul 2025
Línea 160:		Línea 160:

	===[[Non-invasive ventilation]]===		===[[Non-invasive ventilation]]===
	*Consider as alternative to intubation		*Consider as alternative to intubation or pre-oxygenation prior to intubation
	*Alleviates muscle fatigue which leads to larger tidal volumes		*Alleviates muscle fatigue which leads to larger tidal volumes
	*May drive nebulized treatments deeper into airways		*May drive nebulized treatments deeper into airways

Masoodrm: /* Terbutaline */

2025-07-21T17:03:46Z

Terbutaline

← Revisión anterior		Revisión del 17:03 21 jul 2025
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	**Elevated troponins q4hrs during infusion, more common in cTnI vs. cTnT, with EKG changes of ischemia should prompt re-evaluation for stopping infusion<ref>Kalyanaraman M et al. Serial cardiac troponin concentrations as marker of cardiac toxicity in children with status asthmaticus treated with intravenous terbutaline. Pediatr Emerg Care. 2011 Oct;27(10):933-6.</ref>		**Elevated troponins q4hrs during infusion, more common in cTnI vs. cTnT, with EKG changes of ischemia should prompt re-evaluation for stopping infusion<ref>Kalyanaraman M et al. Serial cardiac troponin concentrations as marker of cardiac toxicity in children with status asthmaticus treated with intravenous terbutaline. Pediatr Emerg Care. 2011 Oct;27(10):933-6.</ref>
	*Some experts have nebulized IV form<ref>Lin YZ, Hsieh KH, Chang LF, Chu CY.Terbutaline nebulization and epinephrine injection in treating acute asthmatic children. Pediatr Allergy Immunol. 1996;7(2):95-99.</ref><ref>Rodrigo GJ, Nannini LJ. Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials. Am J Emerg Med. 2006;24(2):217-222.</ref>		*Some experts have nebulized IV form<ref>Lin YZ, Hsieh KH, Chang LF, Chu CY.Terbutaline nebulization and epinephrine injection in treating acute asthmatic children. Pediatr Allergy Immunol. 1996;7(2):95-99.</ref><ref>Rodrigo GJ, Nannini LJ. Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials. Am J Emerg Med. 2006;24(2):217-222.</ref>
	**~~5 mg of IV form~~ [[~~terbutaline~~]]		**[[Terbutaline]] 5 mg IV
	**~~However, significantly higher cost~~ than albuterol		**More expensive than albuterol

	===[[Non-invasive ventilation]]===		===[[Non-invasive ventilation]]===

Masoodrm: /* Workup */

2025-07-21T17:02:00Z

Workup

← Revisión anterior		Revisión del 17:02 21 jul 2025
Línea 36:		Línea 36:
	===Workup===		===Workup===
	Consider [[CXR]] if:		Consider [[CXR]] if:
	*[[Fever]] >102.2°		*[[Fever]] >102.2° F
			*Minimal response to at home medications/treatments
	*Worsening symptoms		*Worsening symptoms
	*~~Poor response to medications/treatments~~		*Diffuse expiratory wheezing
	*~~1st wheeze~~		*Globally diminished breath sounds
	*[[Chest pain]]		*[[Chest pain]]