- Silent chest: no wheeze audible – life‑threatening bronchospasm
- Pulsus paradoxus >25 mmHg: severe obstruction
- Altered mental status: agitation or drowsiness – impending respiratory failure
Asthma Exacerbation (Pediatric)
Must-Not-Miss / Red Flags
Patient Explanation
“Your child’s airways have tightened up, making it harder to breathe. We’ll give them strong medicine through a mask to open up their lungs.”
Board Fact
“The most common trigger for pediatric asthma exacerbation is viral upper respiratory infection (especially rhinovirus).”
ICD-10
J45.901
Definition & Core Concept
An acute asthma exacerbation in children is an episode of progressive increase in shortness of breath, cough, wheezing, and chest tightness due to bronchoconstriction, airway inflammation, and mucus plugging.
Epidemiology & Risk Factors
- Asthma affects 8‑10% of children worldwide
- Most common chronic disease of childhood
- Exacerbations peak in the fall (September “asthma epidemic” after school return)
Clinical Vignette
A 7‑year‑old boy with known asthma presents with severe dyspnea after developing a cold. He has audible wheezing, nasal flaring, and can only speak one word at a time. SpO₂ is 88% on room air.
Pearls & Pitfalls
- If a child is not improving with beta‑agonists, consider alternative diagnoses: foreign body, anaphylaxis, or heart failure.
- The absence of wheezing (“silent chest”) in a severely dyspneic child is an ominous sign indicating minimal air movement.
Discharge & Follow-Up
Review inhaler technique. Ensure appropriate controller therapy (inhaled corticosteroid). Provide written asthma action plan. Follow up with pediatric pulmonology within 2 weeks.
Literature & Guidelines
GINA 2024 Global Strategy for Asthma Management and Prevention. PMID: 38469700.