PhD defence S.A. (Shelley) Boeschoten

Summary:

Asthma is the most common chronic disease in childhood, with a worldwide increase in the number of children with asthma exacerbations requiring pediatric intensive care (PICU) admission. Although mortality is low, children still die every year from asthma. The studies presented in this thesis were performed with the aim to improve knowledge on treatment practices for severe acute asthma (SAA), risk factors for PICU admission, the efficacy and safety of a loading dose of intravenous  salbutamol, and psychosocial outcomes of children with SAA admitted to a PICU. We showed that preventable risk factors for PICU admission were >7 days of symptoms of an asthma exacerbations without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors. The first steps of SAA treatment consists of continuous nebulization with salbutamol and systemic corticosteroids. There is no evidence-based approach after the initial SAA treatment. In the Dutch SAA guideline the next step is continuous infusion of salbutamol. The efficacy of an additional loading dose of salbutamol is still under discussion. In our multicenter, placebo-controlled randomized trial we found no clinical benefit of adding an additional loading dose IV salbutamol. However, it might be effective in an early stage at the emergency department. Psychosocial outcomes such as asthma-related QoL and emotional and behavioral problems, were comparable between SAA children after PICU and general ward admission. However, caregivers in the PICU group showed more post-traumatic stress symptoms.