gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Treatment of Acute Asthma in Children: A Clinical Practice Guideline from the Alexandria University Hospitals, Center for Evidence-Based Clinical Practice Guidelines, Healthcare Quality Directorate and the Alexandria Faculty of Medicine, Department of Pediatrics, Pediatric Respiratory, Allergy & Immunology Unit and Alexandria University Children's Hospital

Meeting Abstract

  • Y. Amer - Alexandria University Hospitals, Healthcare Quality Directorate, EBCPGs Center, Alexandria, Egypt
  • M. Elzalabany - Alexandria University, Faculty of Medicine, Alexandria, Egypt; Alexandria University Hospitals, Healthcare Quality Directorate, EBCPGs Center, Alexandria, Egypt
  • T. Omar - Alexandria University, Faculty of Medicine, Alexandria, Egypt; Alexandria University Hospitals, Healthcare Quality Directorate, EBCPGs Center, Alexandria, Egypt
  • N. Dowidar - Alexandria University Hospitals, Healthcare Quality Directorate, EBCPGs Center, Alexandria, Egypt; Alexandria University, Medical Research Institute, Alexandria, Egypt
  • O. Badr-Eldin - Alexandria University, Faculty of Medicine, Alexandria, Egypt
  • I. Elsawy - Alexandria University, Faculty of Medicine, Alexandria, Egypt
  • M. Eissa - Alexandria University, Faculty of Medicine, Alexandria, Egypt
  • A. Galal - Alexandria University, Faculty of Medicine, Alexandria, Egypt
  • E. Ibrahim - Alexandria University, Faculty of Medicine, Alexandria, Egypt
  • H. Elgamel - Alexandria University Children's Hospital, Alexandria, Egypt
  • M. Abou Gabal - Alexandria University, Faculty of Medicine, Alexandria, Egypt; Alexandria University Children's Hospital, Alexandria, Egypt
  • H. Dhorgham - Alexandria University, Faculty of Medicine, Alexandria, Egypt; Alexandria University Children's Hospital, Alexandria, Egypt

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP115

DOI: 10.3205/12gin227, URN: urn:nbn:de:0183-12gin2276

Published: July 10, 2012

© 2012 Amer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Description: Adaptation of 3 source CPGs for clinicians managing acute asthma in children in PEDs.

Methods: Part1: cross-sectional study (questionnaire survey) for needs assessment of current practice in selected healthcare settings to select topic and justify need for thisCPGs.

Part2: Adaptation (ADAPTE Process).

Recomm.I-1: Children with life threatening asthma/SpO2 <90% receive urgently high flow O2. Recomm.I-2-a: Inhal. β2-agonists are 1st line treatment for acute asthma. Recomm.I-2-b: pMDI+ spacer is preferred in mild-moderate asthma. Recomm.I-2-c: Individualize drug dosing according to severity and response. Recomm.I-2-d: Children with acute asthma in primary care not improved after 10 puffs β2-agonists should be referred to hospital. Recomm.I-2-e: Treat children during transport to hospital by ambulance with O2+nebul. β2-agonists. Recomm.I-2-f: Transfer children with severe-life threatening asthma urgently to hospital to receive nebul. β2-agonists. Recomm.I-2-g: Oral β2-agonists are not recommended for acute asthma. Recomm.I-2-h: For mild-moderate acute asthma, a pMDI+spacer is optimal device. Recomm.I-3-a: If refractory to initial β2-agonist, add ipratropium. Recomm.I-3-b: Repeated doses of ipratropium given early to children poorly responsive to β2-agonists. Recomm.I-3-c: Consider inhaled ipratropium+inhaled β2-agonist for more severe symptoms. Recomm.I-4-a: Prednisolone early in treatment of acute asthma. Recomm.I-4-b: Dose of prednisolone age-dependent. Recomm.I-4-c: Consider steroid tablets in infants early in managing moderate-severe acute asthma in hospitals. Recomm.I-4-d: Steroid tablet therapy is preferred steroid for use. Recomm.I-4-e: Do not initiate inhaled steroids in preference to steroid ablets in acute asthma. Recomm.II-1-a: Consider early single dose of IV salbutamol in severe cases not responding to initial inhaled therapy. Recomm.II-1-b: when inserting IV cannula take sample for serum electrolytes. Recomm.II-2-a: Aminophylline not recommended in mild/moderate acute asthma. Recomm.II-2-b: Consider aminophylline in HDU/PICU for severe/life threatening bronchospasm unresponsive to max. doses of β2-agonists+steroids. Recomm.II-3: IV Magnesium sulphate is safe for acute asthma. Recomm.II-4: ECG monitoring for all IV treatments.