DRUG THERAPY IN THE MANAGEMENT OF ACUTE ASTHMA

Although asthma remains the most common reason for emergency admission to paediatric wards in the UK, the majority of children improve rapidly following treatment with oral steroids and inhaled β2 agonists. Nonetheless, a small number of patients either fail to respond or continue to deteriorate. In these situations there is no substitute for clinical experience and the calming influence that this brings to parents and children. Intravenous therapy with salbutamol or aminophylline should bring about improvements when inhaled therapy has failed. However, there remains controversy about which of these medicines offers the most benefit (or causes the least harm). Although intravenous magnesium seems very likely to be safe, its absolute efficacy as a rescue therapy in childhood asthma remains unknown. The value of nebulised magnesium, oral montelukast and nebulised levalbuterol are yet to be fully established in childhood, although each of these treatments shows promise. Our experience suggests that the most important factor in the management of this group of patients is close clinical observation (on a high-dependency unit if possible) and an ability to remain in control of the situation - this remains part of the art rather than the science of medicine. On rare occasions this includes the need to safely and strategically institute mechanical ventilation in some patients prior to transfer to a paediatric intensive care unit.