Clinical guidelines on pediatric asthma exacerbation in emergency department, a narrative review

  • Shabahang Jafarnejad Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran, Islamic Republic of.
  • Hamidreza Khoshnezhad Ebrahimi | Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran, Islamic Republic of.


Asthma has been known as a prevalent chronic-type inflammatory disease in children, because of their narrower respiratory airways. The present study aimed to identify guidelines for children asthma treatments. Extensive research was conducted on biomedical and pharmacological bibliographic database PubMed, EMBASE, MEDLINE, LILACS database, global independent network of Cochrane, Science Direct and global health library of Global Index Medicus. A comprehensive literature review was carried out using the terms Pediatric Asthma, epidemiology, management, and related clinical guidelines published from 2000 to 2019. After the primary assessment, quick diagnosis, clinical practice guidelines are useful tools for proper management of pediatric Asthma. By setting proper guidelines for this particular population, a higher improvement in quality of management of of pediatric Asthma is expected. Given the differences between the recommendations arisen by BTS/SIGN and NICE guidelines, critical comparison of the evidence-base guidelines provide suggestions that have more in common than what might seems at the first glance. The analysis of the variations presented in the present article will assist clinicians to make accurate decisions regarding their patients.



PlumX Metrics


Download data is not yet available.


Control CFD. Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education --- United States, 2001--2009.Centers for Disease Control and Prevention 2011 / 60(17);547-552

Bateson TF, Schwartz J. Children's response to air pollutants. Journal of Toxicology and Environmental Health, Part A, 2007;71: 238-243. DOI:

Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. Vital Health Stat 10. 2013;258:1-81.

Akinbami LJ, Moorman JE, Liu X. Asthma prevalence, health care use, and mortality; United States, Natl Health Stat Report. 2011;32:1-14.

Grimshaw JM, Eccles MP, Walker AE, et al., Changing physicians' behavior: what works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002;22:237-43. DOI:

Sheldon G, Anthony Heaton P, Palmer S, et al., Nursing management of paediatric asthma in emergency departments. Emerg Nurse. 2018;26:32-42 DOI:

Health NI.National asthma education and prevention program. Expert panel report, 1997.p. 3.

Ellwood P, Asher MI, Beasley R, et al., The International Study of Asthma and Allergies in Childhood (ISAAC): Phase Three rationale and methods [Research Methods]. Int J Tuberc Lung Dis. 2005;9:10-6.

Weiland SK, Björkstén B, Brunekreef B, et al., Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir J. 2004;24:406-12. DOI:

Asher MI, Keil U, Anderson HR, et al., International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8:483-91. DOI:

Asher MI, Montefort S, Björkstén B, et al., Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733-43. DOI:

Loftus PA, Wise SK. Epidemiology and economic burden of asthma. in International forum of allergy & rhinology. 2015. Wiley Online Library. DOI:

Pollock J, Shi L, Gimbel RW. Outdoor environment and pediatric asthma: an update on the evidence from North America. Can Respir J. 2017;2017:8921917. DOI:

Turner S. Predicting and reducing risk of exacerbations in children with asthma in the primary care setting: current perspectives. Pragmat Obs Res. 2016;7:33-39 DOI:

Foy AJ, Liu G, Davidson WR Jr, et al., Comparative effectiveness of diagnostic testing strategies in emergency department patients with chest pain: an analysis of downstream testing, interventions, and outcomes. JAMA Intern Med. 2015;175:428-36 DOI:

Gorelick MH, Schremmer R, Ruch-Ross H,et al., Current workforce characteristics and burnout in pediatric emergency medicine. Acad Emerg Med. 2016;23:48-54 DOI:

Remick K, Gausche-Hill M, Joseph MM, et al., Pediatric readiness in the emergency department. Pediatrics, 2018:142: e20182459. DOI:

Bush A, Fleming L. Diagnosis and management of asthma in children. BMJ, 2015. 350: h996. DOI:

Hardinge M, Annandale J, Bourne S, et al., British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax, 2015;70: i1-i43. DOI:

Cabana MD, Slish KK, Nan B, et al., Asking the correct questions to assess asthma symptoms. Clin Pediatr (Phila). 2005;44:319-25. DOI:

Gupta RS, Weiss KB. The 2007 National Asthma Education and Prevention Program asthma guidelines: accelerating their implementation and facilitating their impact on children with asthma. Pediatrics, 2009;123: S193-S198. DOI:

Lauer MS, Kiley JP, Mockrin SC, et al., National Heart, Lung, and Blood Institute (NHLBI) strategic visioning: setting an agenda together for the NHLBI of 2025. Circulation. 2015;131:1106-9 DOI:

Johnson LH, Chambers P, Dexheimer JW. Dexheimer, Asthma-related emergency department use: current perspectives. Open Access Emerg Med. 2016 ;8:47-55 DOI:

National Heart, L. and B. Institute, Expert panel report 3 (EPR3): guidelines for the diagnosis and management of asthma. http://www. nhlbi. nih. gov/guidelines/asthma/, 2007.

James DR, Lyttle MD. British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014. Arch Dis Child Educ Pract Ed. 2016;101:319-322 DOI:

Qureshi F, Pestian J, Davis P, et al., Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med. 1998;339:1030-5. DOI:

Turner S, Richardson K, Murray C, et al., Long-acting β-agonist in combination or separate inhaler as step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids. J Allergy Clin Immunol Pract. 2017;5:99-106.e3 DOI:

Kelly AM, Kerr D, Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma?. Respir Med. 2004;98:777-81. DOI:

DiBlasi RM, Cheifetz IM. Neonatal and pediatric respiratory care: what does the future hold?. Respir Care. 2011;56:1466-80 DOI:

Massingham K, Fox S, Smaldone A. Asthma therapy in pediatric patients: a systematic review of treatment with montelukast versus inhaled corticosteroids. J Pediatr Health Care. 2014;28:51-62 DOI:

Paul S, Garg A, Garg N. Managing asthma in children: a flexible approach. British J Family Med, 2014: 4: 28-31.

Lyttle MD, O'Sullivan R, Doull I, et al., Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice. Arch Dis Child. 2015;100:121-5. DOI:

Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta‐agonists for acute asthma. Cochrane Database Syst Rev. 2003;:CD001115. DOI:

Ortiz-Alvarez O, Mikrogianakis A. Managing the paediatric patient with an acute asthma exacerbation. Paediatr Child Health. 2012;17:251-62 DOI:

Schuh S, Sweeney J, Freedman SB, et al., Magnesium nebulization utilization in management of pediatric asthma (MagNUM PA) trial: study protocol for a randomized controlled trial. Trials. 2016;17:261. DOI:

Mark NA. A structured approach is key to diagnosing asthma By Professor Hilary Pinnock 2016:12:18-22

White, J, Paton J, Niven R, et al., Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 2018:73:293-297. DOI:

Rowe BH, Villa-Roel C, Majumdar SR, et al., Rates and Correlates of Relapse Following ED Discharge for Acute Asthma. Chest. 2015;147:140-149. DOI:

Arellano FM, Arana A, Wentworth CE, et al., Frequency of prescription of inhaled corticosteroids to children with asthma in US emergency departments. Pediatr Allergy Immunol. 2011;22:469-76. DOI:

Walsh-Kelly CM, Kelly KJ, Drendel AL, et al., Emergency department revisits for pediatric acute asthma exacerbations: association of factors identified in an emergency department asthma tracking system. Pediatr Emerg Care. 2008;24:505-10. DOI:

Croisant S, Epidemiology of asthma: prevalence and burden of disease, in Heterogeneity in asthma. 2014:17-29. DOI:

Sin DD, Man SP. Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma. Archives Inter Med, 2002;162: 1591-1595. DOI:

Scarfone RJ, Zorc JJ, Angsuco CJ. Emergency physicians' prescribing of asthma controller medications. Pediatrics, 2006:117: 821-827. DOI:

Lovinsky S,Rastogi D. Prescription habits for preventative medications among pediatric emergency department physicians at an inner-city teaching hospital. J Asthma, 2010;47: 1011-1014. DOI:

Sampayo EM, McLoughlin RJ, Tsevdos D, et al., Pediatricians support initiation of asthma controller medications in the emergency department: a national survey. Pediatr Emerg Care. 2015;31:545-50. DOI:

Meltzer EO, Shaikh A, Engel M, et al. Effect Of Tiotropium Respimat® 2.5 μg Add-On To ICS Or ICS+ Controller Medications On Clinical Outcomes In Adults And Adolescents With Asthma Across Severities. B32. THERAPEUTIC TRIALS IN ASTHMA 2017:A3183-A3183.

Matsui EC,Wood RA. Low-dose inhaled corticosteroid therapy and risk of emergency department visits for asthma. Pediatrics, 2003;112:483-483.

Ducharme FM, Zemek RL, Chalut D, et al., Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control. Am J Respir Crit Care Med. 2011;183:195-203. DOI:

Baren JM, Shofer FS, Ivey B, et al., A randomized, controlled trial of a simple emergency department intervention to improve the rate of primary care follow-up for patients with acute asthma exacerbations. Ann Emerg Med. 2001;38:115-22. DOI:

Ly CD, Dennehy CE. Emergency department management of pediatric asthma at a university teaching hospital. Ann Pharmacother. 2007 ;41:1625-31. DOI:

Pediatric asthma, child health, Emergency Department, emergency care, clinical guidelines
  • Abstract views: 1185

  • PDF: 465
  • HTML: 8
How to Cite
Jafarnejad, S., & Khoshnezhad Ebrahimi, H. (2020). Clinical guidelines on pediatric asthma exacerbation in emergency department, a narrative review. European Journal of Translational Myology, 30(1), 179-186.