Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Children's Hospital, Parow, Cape Town, South Africa.
S Afr Med J. 2013 Feb 5;103(3 Pt 3):199-207. doi: 10.7196/samj.6658.
Acute asthma exacerbations remain a common cause of hospitalisation and healthcare utilisation in South African children.
To update the South African paediatric acute asthma guidelines according to current evidence, and produce separate recommendations for children above and below 2 years of age.
A working group of the South African Childhood Asthma Group was established to review the published literature on acute asthma in children from 2000 to 2012, and to revise the South African guidelines accordingly.
Short-acting inhaled bronchodilators remain the first-line treatment of acute asthma. A metered-dose inhaler with spacer is preferable to nebulisation for bronchodilator therapy to treat mild to moderate asthma. Two to four puffs of a short-acting bronchodilator given every 20 - 30 minutes, depending on clinical response, should be given for mild attacks; up to 10 puffs may be needed for more severe asthma. Children with severe asthma or oxygen saturation (SpO2) <92% should receive oxygen and frequent doses of nebulised beta-2-agonists, and be referred to hospital. Nebulised ipratropium bromide (via nebulisation or multidosing via pMDI-spacer combination) should be added if there is a poor response to three doses of β2-agonist or if the symptoms are severe. Early use of corticosteroids reduces the need for hospital admission and prevents relapse; oral therapy is preferable. Assessment of acute asthma in children below the age of 2 years can be difficult, and other causes of wheezing must be excluded. Treatment of acute asthma in this age group is similar to that of older children.
Effective therapy for treatment of acute asthma - primarily inhaled short-acting β2-agonists, oral corticosteroids and oxygen with appropriate delivery systems - should be available in all healthcare facilities and rapidly instituted for treatment of acute asthma in children.
The guideline document was endorsed by the Allergy Society of South Africa (ALLSA), the South African Thoracic Society (SATS), the National Asthma Education Programme (NAEP), the South African Paediatric Association (SAPA) and the South African Academy of Family Practice.
急性哮喘加重仍然是南非儿童住院和医疗保健利用的常见原因。
根据现有证据更新南非儿科急性哮喘指南，并为 2 岁以上和以下儿童制定单独的建议。
南非儿童哮喘小组的一个工作组成立，以审查 2000 年至 2012 年期间发表的关于儿童急性哮喘的文献，并相应修改南非指南。
短效吸入型支气管扩张剂仍然是急性哮喘的一线治疗药物。对于轻度至中度哮喘的支气管扩张治疗，带雾化器的计量吸入器优于雾化器。对于轻度发作，应根据临床反应每 20-30 分钟给予 2-4 喷短效支气管扩张剂；对于更严重的哮喘，可能需要 10 喷。对于严重哮喘或血氧饱和度（SpO2）<92%的儿童，应给予氧气和频繁给予雾化β2-激动剂，并转至医院。如果对 3 剂β2-激动剂反应不佳或症状严重，应添加雾化吸入异丙托溴铵（通过雾化或通过 pMDI-雾化器组合多次给药）。早期使用皮质类固醇可减少住院需求并预防复发；口服治疗是首选。对于 2 岁以下儿童急性哮喘的评估可能较为困难，必须排除其他喘息原因。该年龄段儿童急性哮喘的治疗与年长儿童相似。
所有医疗保健设施都应提供有效的急性哮喘治疗药物，包括主要吸入用短效β2-激动剂、口服皮质类固醇和适当输送系统的氧气，并迅速用于治疗儿童急性哮喘。
该指南文件得到了南非过敏学会（ALLSA）、南非胸科学会（SATS）、国家哮喘教育计划（NAEP）、南非儿科学会（SAPA）和南非家庭实践学院的认可。
