Severe acute asthma
Severe acute asthma (SAA) is life threatening and warrants fast and effective intervention. The severity of SAA can be assessed through a focused and concise clinical examination. Important signs of a life threatening attack are decreased consciousness, imminent exhaustion, oxygen saturation below 85% and diminished air movement on auscultation (silent chest). The severity of SAA can be expressed in an asthma score. The relative contribution of airway inflammation, bronchoconstriction and mucusplugging must be weighed for treatment choices. The pillars of treatment of SAA in the general pediatric practice are oxygen, continuous nebulization of salbutamol, systemic corticosteroids, intravenous magnesium sulphate and perhaps intravenous salbutamol. Further steps in treatment of unresponsive SAA should be initiated in consultation with the pediatric intensive care. Reasons for transfer to a pediatric intensive care are imminent exhaustion and/or respiratory insufficiency, need for mechanical ventilation and intravenous salbutamol.