Pharmacologic management of the hospitalized pediatric asthma patient

The incidence of asthma continues to rise and is associated with significant morbidity and mortality. Acute asthma exacerbations warranting hospitalization should be aggressively treated with inhaled selective β2-agonists, inhaledIB, and oral or parenteral steroids. Aminophylline no longer is recommended for acute treatment, but continues to be useful in the outpatient setting. Magnesium levels should be obtained early and replacement considered. Helium-oxygen mixtures, which can be administered by facemask, are well-tolerated and should be considered early if patients are not improving. Failure of conventional therapy merits use of aggressive adjunct treatment, such as IV β2-agonist, ketamine, antihistamines, and noninvasive and invasive mechanical ventilation. Rarely, inhalational anesthetics may be helpful and require complex delivery systems and have potential significant side effects. If all therapy fails, extracorporeal membrane oxygen (ECMO) can be instituted and is successful, especially if instituted prior to cardiopulmonary arrest.