Asthma is a chronic disease of the tracheobronchial tree characterized by airway obstruction, inflammation, and hyperresponsiveness. Triggers for cytokine-mediated inflammation and hyperresponsiveness are well known and can be as innocuous as changes in barometric pressure. The cascade of events leading to mucous plugging, airway edema, and obstruction is generally reversible with appropriate, aggressive therapy. Symptoms of asthma can vary from overt wheezing to paroxysmal dyspnea to cough. In the absence of audible wheezing, the child may frequently go undiagnosed, which may lead to high morbidity as the disease goes untreated. The need for parents, caretakers, and physicians to correctly assess the severity of the disease and provide adequate and timely treatment is paramount to the care of children with asthma.

The National Institutes of Health (NIH) 1997 Expert Panel Report 2 (EPR-2), Guidelines for the Diagnosis and Management of Asthma,1 is a publication with which all physicians should be familiar. It provides treatment algorithms for use in the acute-care setting and clear guidelines to outpatient management ( Fig 120-1). However, most institutions will need to tailor these protocols to meet regional, local, and individual hospital needs.

FIG. 120-1. Management of asthma exacerbations: emergency department and hospital-based care. (From the National Institutes of Health, National Heart, Lung, and

Blood Institute.)

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Dealing With Asthma Naturally

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