Management of asthma exacerbation in the emergency departments

Asthma is one of the most common pediatric emergencies among children throughout the world, where an estimated 300 million individuals are affected [1]. The prevalence of asthma in Saudi Arabia is 23% according to Alfrayeh [2]. Most asthma is uncontrolled and Jahdali estimated that up to 64% of patients have uncontrolled asthma [3]. Morbidity related to asthma has also increased in recent years. In addition, hospitalization for asthma has increased [4]. However, mortality due to asthma is decreasing worldwide [5]. Asthma is one of the main causes of health care utilization and the costs related to asthma are increasing [6]. Approximately 50% of pediatric asthma cases are still uncontrolled in Saudi Arabia, even in tertiary centers [7]. Numerous guidelines are available online and the guidelines of the Saudi Initiative for Asthma (SINA), which were updated in 2016, are very useful for the pediatric age group [8]. The availability of asthma guidelines can improve the outcomes of asthma in children [9]. In general, asthma treatments that involve the administration of oxygen, inhaled bronchodilators, systemic steroids, and anticholinergic agents are common, and these agents are the main forms of therapy. Frequent assessments and monitoring the response to these therapies are crucial for tailoring medications to needs. In this study, we aimed to minimize the controversy regarding asthma exacerbation management by providing the best evidence for patient care according to the resources available at a specific institute [10]. 1.1. Definition of exacerbation Asthma exacerbation is recognized clinically based on the following features: progressive increase in shortness of breath, coughing, wheezing, or chest tightness, and a progressive reduction in lung function that requires medical intervention [5,11]. An exacerbation may include an increase in coughing, especially when the child is asleep, a decrease in exercise tolerance, impairment of daily activities, and acute or sub-acute increases in wheezing or shortness of breath [12,13].