Pediatric Status Asthmaticus Medication

  • Author: Adam J Schwarz, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Oct 26, 2011
 

Medication Summary

Management goals for status asthmaticus are (1) to reverse airway obstruction rapidly through aggressive use of beta2-agonist agents and early use of corticosteroids, (2) to correct hypoxemia by monitoring and administering supplemental oxygen, and (3) to prevent or treat complications such as pneumothorax or respiratory arrest.

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Beta2-agonist agents

Class Summary

These agents relax airway smooth muscle, thus causing bronchodilation in patients with reversible airway obstruction such as asthma.

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Albuterol (Proventil, Ventolin, ProAire)

 

Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility.

Administer continuous nebulization through pump-driven aerosol or via small-particle aerosol generator

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Levalbuterol (Xopenex)

 

A selective beta2-agonist. Albuterol is a racemic mixture, while levalbuterol contains only the levo isomer of albuterol. Safety and efficacy have not been determined in children < 12 y; multicenter trials in children 0-12 y are ongoing.

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Terbutaline (Brethine)

 

Selective beta2-adrenergic agent produces relaxation of airway smooth muscle, resulting in bronchodilation in patients with asthma.

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Anticholinergic agents

Class Summary

These agents are used for bronchodilation in patients with bronchospasm associated with asthma or chronic obstructive pulmonary disease (COPD).

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Ipratropium bromide (Atrovent)

 

Chemically related to atropine. Has antisecretory properties and, when applied locally, inhibits secretions from serous and seromucous glands lining the nasal mucosa. Inhibits acetylcholine at parasympathetic sites in bronchial smooth muscle, resulting in bronchodilation.

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Corticosteroids

Class Summary

These agents decrease inflammatory response observed in asthma. They also decrease capillary leak and augment beta-receptor response to beta-adrenergic agents.

Methylprednisolone (Solu-Medrol, Medrol); Prednisone

 

Interferes with arachidonic acid metabolism and production of leukotrienes, reduces microvascular leakage, reduces cytokine production, and prevents migration of inflammatory cells.

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Other bronchodilator therapy

Class Summary

These agents are used as additional therapy for patients who remain in refractory status asthmaticus despite maximal inhalational therapy and the use of corticosteroids. These medications may be administered intravenously.

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Theophylline

 

Bronchodilator in patients with reversible bronchospasm associated with asthma or COPD. Mechanism of action of theophylline is unclear, but its beneficial effects in asthma are thought to result from bronchodilation partly caused by phosphodiesterase inhibition, improved diaphragmatic inotropicity, CNS stimulation of the respiratory drive, and possible anti-inflammatory effects.

Start PO (eg, Slo-bid, Slo-Phyllin, Theolair, Theo-24, Uni-Dur, Theobid) dosing when patient is stable on continuous IV dose.

Theophylline is administered PO.

Aminophylline can be administered PO or IV. However, IV aminophylline is generally used for refractory status asthmaticus because of the severity of the patient's asthma, which results in the decision to add methylxanthines to the treatment regimen.

Aminophylline IV is 79% theophylline.

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Magnesium sulfate

 

Relaxes smooth muscle and may lead to adjunctive bronchodilation. Mechanism of action unknown, but may compete with calcium for smooth muscle binding sites leading to relaxation.

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Contributor Information and Disclosures
Author

Adam J Schwarz, MD  Consulting Staff, Critical Care Division, Pediatric Subspecialty Faculty, Children's Hospital of Orange County

Adam J Schwarz, MD is a member of the following medical societies: American Academy of Pediatrics and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD, FCCM  Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

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Figure depicting antigen presentation by the dendritic cell with the lymphocyte and cytokine response leading to airway inflammation and asthma symptoms.
 
 
 
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