From the Guidelines
High flow nasal cannula (HFNC) should not be used as a primary treatment for asthma exacerbations in children, as the current evidence prioritizes standard treatments such as oxygen, inhaled b2-agonists, and systemic corticosteroids 1. When considering supportive therapies for children with moderate to severe asthma exacerbations, HFNC may be considered in specific cases where conventional oxygen therapy is insufficient, but its use should be carefully weighed against the potential benefits and risks. The primary treatment for asthma exacerbations, as recommended by the NAEPP Expert Panel, consists of administration of oxygen, inhaled b2-agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation 1. Key considerations for the management of asthma exacerbations in children include:
- Immediate evaluation and triage
- Prompt institution of treatment based on the severity of the exacerbation
- Close monitoring of the patient's response to treatment
- Adjustment of treatment as needed to ensure adequate control of symptoms and prevention of complications
- Consideration of HFNC as an adjunct therapy in select cases, but not as a replacement for evidence-based treatments. It is essential to note that the use of HFNC in children with asthma exacerbations should be guided by the individual patient's needs and response to treatment, and should always be used in conjunction with standard asthma therapies.
From the Research
Treatment of Asthma Exacerbations in Children
- The use of high flow nasal cannula (HFNC) for asthma exacerbations in children is not directly mentioned in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss various treatment options for asthma exacerbations in children, including the use of corticosteroids, bronchodilators, and biologic agents 2.
- Nebulized inhaled corticosteroids have been shown to be effective in managing acute asthma exacerbations in children 5 years or younger 3.
- Ipratropium bromide, a quaternary anticholinergic bronchodilator, has been used as adjunctive therapy for the emergency treatment of acute asthma exacerbation in children and adults 4.
- The combination of ipratropium and beta2-agonists has been shown to improve lung function and decrease hospitalization rates in children with severe asthma exacerbations 4.
Gaps in Current Guidelines
- The current guidelines for asthma management in children have gaps, including the use of bronchodilators and inhaled corticosteroids with single maintenance and reliever therapy, and long-acting muscarinic antagonists in children 2.
- There is limited evidence for the treatment of asthma in children under 5 years of age, highlighting the need for further research in this area 2.
Emerging Treatments
- New treatment strategies and agents have emerged in the treatment of pediatric asthma, including biologics for patients who are difficult to treat 2.
- Pharmacists play a key role in providing education about, dispensing, and recommending the newest evidence-based treatment options for children with asthma 2.