Approaches to acute asthma and status asthmaticus in children.

Asthma is the most common chronic disease in pediatric patients and is the leading cause of childhood disability. The functional abnormalities of this disease--namely, airway obstruction and hyperresponsiveness--are consequences primarily of airway inflammation. Outpatient therapy for acute asthma, as well as therapy for status asthmaticus (episodes of asthma unresponsive to usually effective outpatient therapy and necessitating hospitalization), primarily addresses treatment of airway inflammation. The goal of office and emergency room management of acute asthma is reversal of airway obstruction by the administration of inhaled beta-adrenergic medications. The therapy for status asthmaticus consists of intravenously administered aminophylline, corticosteroids, nebulized beta-adrenergic agents, and oxygen. Respiratory failure, the inability to maintain adequate elimination of CO2, may be effectively treated by adding continuous nebulization of albuterol. Mechanical ventilation will still be necessary in the rare patient who does not respond to pharmacologic therapy. Acute exacerbations of asthma, as well as status asthmaticus, can best be prevented by establishing effective maintenance programs individualized for each patient.