Management of the acute asthma

Before starting treatment for paediatric acute asthma a brief patient data must be obtained about previous asthma history. Treatment should include the use of oxygen, shortacting beta-adrenergic drugs, and systemic steroids. Mild and moderate asthma attacks can be treated at the Primary Care Paediatric Office, where oxygen source and a pulsyoxymeter device should be available. Drug dosage and administration schedules must be modified in relation with the exacerbation severity and patient response to therapy. In severe acute asthma, addition multiple inhaled ipratropium doses may bring some benefits to the betaadrenergic drugs alone. The best way for both beta-adrenergic and ipratropium is inhaled way, nebulization or inhalation with an inhalator and spacer, and it is necessary to be sure that child use the spacer properly. Steroids have an excellent anti-inflammatory action, by modulating the synthesis, liberation and activity of inflammation mediators, and its effectiveness has been shown when used early and in a systemic pattern. The clinical effect of steroids is not immediate, therefore must not be the first nor the only drug used. Currently, inhaled administration of steroids in the treatment of acute asthma exacerbation is not recommended. In case of severe asthma exacerbation, there are other therapeutic options as theophylline, magnesium sulphate, and other Intensive Care Unit measures if necessary.