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Acute asthma exacerbations in children: Inpatient management

Gregory Sawicki, MD, MPH
Kenan Haver, MD
Section Editors
Robert A Wood, MD
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS


More than 6.1 million children in the United States have asthma, which accounts for approximately 135,000 hospitalizations each year [1-3]. Although exacerbations are common, most are mild and can be managed successfully at home. Children with severe exacerbations or those who fail to improve with outpatient therapy may need to be evaluated and treated in an urgent care or emergency department (ED), and some will need to be admitted to the hospital for further management.

Inpatient management of acute asthma exacerbation in children is discussed here. Outpatient and intensive care unit (ICU) management are discussed separately. (See "Acute asthma exacerbations in children: Home/office management and severity assessment" and "Acute asthma exacerbations in children: Emergency department management" and "Acute severe asthma exacerbations in children: Intensive care unit management".)


Most children who require admission for asthma are initially treated in the emergency department (ED), although some are admitted directly from clinicians' offices. Thus, inpatient treatment is typically a continuation of therapies and monitoring that were started in the ED (algorithm 1) [4]. Patients usually have received several albuterol treatments, often combined with ipratropium (children with an asthma exacerbation experience a lower risk of admission to the hospital if they are treated with the combination of inhaled short-acting beta agonists [SABAs] plus anticholinergic versus SABA alone [5]), systemic glucocorticoids, and supplemental oxygen, when necessary, before arrival to the inpatient unit. The criteria for admission are discussed in detail separately. (See "Acute asthma exacerbations in children: Emergency department management", section on 'Hospitalization'.)

Communication among the referring clinicians, providers in the ED, and those caring for the patient in the hospital is essential to ensure that treatments ordered in the ED are not missed or duplicated during the transfer of care.

Inpatient therapy consists of [6,7]:

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Literature review current through: Sep 2017. | This topic last updated: Dec 09, 2015.
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