Analysis of eosinophil and lymphocyte concentrations on the incidence of mild and severe acute asthma exacerbations

Introduction: Exacerbation of asthma is an episode characterized by an increase in symptoms of progressive shortness of breath, coughing, wheezing, chest tightness, and a progressive decrease in lung function. Among the cells involved and activated in acute exacerbations in asthma are eosinophils and lymphocytes.

Efficacy of A Loading Dose of IV Salbutamol in Children With Severe Acute Asthma Admitted to A PICU: A Randomized Controlled Trial

The optimal dose regimen to start intravenous (IV) treatment in children with severe acute asthma (SAA), is still matter of debate. We assessed the efficacy of an additional salbutamol loading dose in children with SAA admitted to a pediatric intensive care unit (PICU). This multicenter, placebo-controlled randomized trial in the PICUs of four tertiary care children’s hospitals included children (2-18 years) with SAA admitted between 2017-2019. Children were randomized to receive either a loading dose IV salbutamol (15 mcg/kg, max.750 mcg) or normal saline while on continuous salbutamol infusion. The primary outcome was asthma score (Qureshi) 1 hour after the intervention. Analysis of covariance models were used to evaluate sensitivity to change in asthma scores. Serum concentrations of salbutamol were obtained. Fifty-eight children were included (29 in the intervention group). Median baseline asthma score was 12 (IQR 10-13) in the intervention and 11 (9-12) in the control group (p=0.032). The asthma score 1 hour after the intervention did not differ significantly between both groups (p=0.508, β-coefficient=0.283). The median increase in salbutamol plasma levels 10 minutes after the intervention was 13μg/L (5-24) in the intervention and 4μg/L (0-7) in the control group (p=0.001). Mixed model analyses showed a significant association between heart rate and asthma score, adjusted for salbutamol plasma levels. Conclusion: We found no clinical benefit of a loading dose IV salbutamol, compared to normal saline in children with SAA admitted to the PICU. Clinicians should be less reluctant to increase the dose of salbutamol infusion, solely based on tachycardia.

Severe Acute Asthma (Status Asthmaticus)

Key Points Initiate high- flow oxygen therapy to maintain oxygen saturation of greater than 90%.Dexamethasone is as effective as methylprednisolone and should be given as soon as possible.Intravenous magnesium sulfate is a useful adjunct if therapy with β-agonists and anti-cholinergics are not effective initially.