Asthma in children younger than 12 years: Rescue treatment for acute symptoms
- Gregory Sawicki, MD, MPH
Gregory Sawicki, MD, MPH
- Assistant Professor of Pediatrics
- Harvard Medical School
- Kenan Haver, MD
Kenan Haver, MD
- Assistant Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
- Gregory Redding, MD
Gregory Redding, MD
- Section Editor — Pediatric Pulmonology
- Professor of Pediatrics
- University of Washington School of Medicine
Rescue medications are primarily taken to relieve the bronchoconstriction that occurs with acute asthma symptoms, although some agents may have additional effects. Quick-relief agents include short-acting beta agonists (SABAs), anticholinergic bronchodilators (eg, ipratropium bromide), and short-term systemic glucocorticoids.
Medications used for the quick relief of asthma symptoms in children younger than 12 years of age are reviewed here. The recommendations below are based upon National Asthma Education and Prevention Program (NAEPP) expert panel guidelines published in 2007 , which are similar to other major published asthma guidelines [2,3].
The management of acute asthma exacerbations in children is discussed in detail separately. (See "Acute asthma exacerbations in children: Emergency department management" and "Acute asthma exacerbations in children: Inpatient management".)
Prophylactic use of quick-relief agents, such as SABAs prior to anticipated triggers (eg, exercise, allergen exposure), is discussed in detail separately. (See "Beta agonists in asthma: Acute administration and prophylactic use", section on 'Use in exercise-induced asthma' and "Exercise-induced bronchoconstriction" and "Beta agonists in asthma: Acute administration and prophylactic use", section on 'Prophylaxis in allergen-induced asthma'.)
SHORT-ACTING BETA AGONISTS
Short-acting beta agonists (SABAs), such as albuterol (salbutamol) and levalbuterol, remain a cornerstone of the treatment of childhood asthma . SABAs relax airway smooth muscle, leading to a prompt increase in airflow. These drugs generally provide rapid relief of acute asthma symptoms (eg, coughing, wheezing, chest tightness, and shortness of breath), with a time to onset of action of approximately 5 to 10 minutes, peak effect beginning within approximately 50 minutes, and duration of action of approximately three to six hours. Thus, as-needed use of these drugs is the primary therapy for acute symptoms in patients with intermittent asthma (figure 1A and figure 1B) and also is first-line therapy in patients with acute exacerbations. (See "Beta agonists in asthma: Acute administration and prophylactic use" and "Acute asthma exacerbations in children: Emergency department management" and "Acute asthma exacerbations in children: Inpatient management".)
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