1. Dr Rakesh Kumar Asst. Professor Dept. Of Paediatrics N.M.C.H, Patna Evidence based management of Acute Exacerbation of Asthma in children aged 0-18 years

2. Introduction Asthma is a disease of the respiratory tract characterized by recurrent and/or chronic episodes of airway inflammation and obstruction (manifested by wheeze or cough, or demonstrated upon pulmonary function testing) and evidence of reversibility of obstruction.

3. Epidemiology Prevalence of asthma in children continues to show an increasing trend with reported rates between 8.5% and 8.9% (akinbami 2009, kamble 2009) Asthma is most prevalent in children 5 to 14 years Among children younger than 18 years of age, asthma is more prevalent in males. ( akinbami 2009, moorman 2007)

4. Initial history & Physical examination Time of onset of current exacerbation. Current medications and allergies. Recent frequent use of beta2-agonists. Risk factors for predicting severe, uncontrolled disease are : ED visits, admissions to the hospital and ICU, and prior intubations. exposure to asthma triggers.

5. Whenever a child present to ED with acute exacerbation of asthma we try to classify him into mild, moderate & severe exacerbation according to -Symptoms -Signs -Functional assessment

6. Asthma exacerbation severity (Symptoms) mild moderate severe Imminent resp arrest Breathlessnes s While walking Can lie down @ rest (difficulty feed) Prefer sitting @ rest Sits upright Talks in sentence phrases words Cant talk Alertness normal agitated agitated Drowsy or confused

7. Asthma exacerbation severity (Signs) mild moderate severe Imminent resp arrest Resp. Rate (according to age) N or Increase Increased Increased Often > 30 Normal or decreased Acessory muscle use Usually not commonly usually Paradoxical thoracoabd mov Wheeze Moderate, end exp Loud, throughout exh Loud or absent Minimal or absent Pulse rate (@ presentation) < 100 100-120 > 120 bradycardia Pulsus Paradoxus Absent ,= 70% 40-69%