Salbutamol in the Pediatric Emergencies: Nebulization Estimated Via AerogeN or Jet
Salbutamol in the Pediatric Emergencies: Nebulization Estimated Via AerogeN or Jet
Controlled trial of nebulized salbutamol using jet nebulizer or vibrating mesh technology in
 children presenting with acute moderate to severe asthma.
Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma
 causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness,
 shortness of breath, and coughing. The coughing often occurs at night or early in the
 morning. Sometimes asthma symptoms are mild and go away on their own or after minimal
 treatment with asthma medicine. Other times, symptoms continue to get worse. When symptoms
 get more intense and/or more symptoms occur, it is called an asthma attack. Asthma attacks
 also are called flare-ups or exacerbation.

 International Study of Asthma and Allergies in Childhood (ISAAC) found that about 14% of the
 world's children were likely to have had asthmatic symptoms in the last year and, crucially,
 the prevalence of childhood asthma varies widely between countries, and between centers
 within countries studied. These conclusions resulted from ISAAC's groundbreaking survey of a
 representative sample of 798,685 children aged 13-14 years in 233 centers in 97 countries.
 (ISAAC also studied a younger age group of children (6-7 years) and the findings were
 generally similar to the older children). These adolescents were asked whether they had
 experienced wheeze in the preceding 12 months. Prevalence of recent wheeze varied widely. The
 highest prevalence (>20%) was generally observed in Latin America and in English-speaking
 countries of Australasia, Europe and North America as well as South Africa. The lowest
 prevalence (<5%) was observed in the Indian subcontinent, Asia-Pacific, Eastern
 Mediterranean, and Northern and Eastern Europe. In Africa, 10-20% prevalence was mostly
 observed .

 The majority of children with asthma have stable disease, and only a minority experience
 exacerbations needing hospitalization or emergency room visits. In older children, recent
 advances in treatment seem to have reduced chronic morbidity as well as the number of acute
 exacerbations. In infants and younger children, this goal may be more difficult to achieve,
 given the heterogeneity of obstructive lung disease in this age group. Viral wheeze is a very
 common clinical scenario in young children, and identification and proper treatment of
 subjects with potential for development of asthma and future exacerbations is still an
 unresolved challenge. Even if severe asthma exacerbations are relatively common, mortality
 from asthma in children is rare and declining. In the United Kingdom the mortality rate for
 children 0-14 years is less than one per 100.000 children per year. In contrast, there has
 been a vast increase in the economic costs associated with asthma. However, the main economic
 burden of childhood asthma is linked to indirect costs, long-term follow up and medication,
 and not to hospitalization .

 Acute severe asthma represents one of the most common medical emergency situations and the
 most serious clinical presentation of asthma. Asthma is typically characterized by the
 presence of severe respiratory distress due to an asthma episode that requires the use of
 bronchodilators, oxygen and corticosteroids. Asthma attack can be severe and even life
 threatening. Features of acute severe attack include; Peak expiratory flow (PEF) 33-50% of
 best (use % predicted if recent best unknown), tachycardia and tachypnea. Life threatening
 attack includes pulse oxymetry <92%, Silent chest, cyanosis, or feeble respiratory effort,
 Arrhythmia or hypotension Exhaustion, altered consciousness. A severe asthma exacerbation can
 usually be presented clinically with dyspnea at rest; interferes with conversation and peak
 expiratory flow rate (PEFR) < 40%, usually requires hospitalization .

 Acute severe asthma is one of the most common medical emergency situations in childhood, and
 physicians caring for acutely ill children are regularly faced with this condition. The
 cornerstones of the management of acute asthma in children are rapid administration of
 oxygen, inhalations with bronchodilators and systemic corticosteroids. Inhaled
 bronchodilators may include selective b2-agonists, adrenaline and anticholinergics.
 Additional treatment in selected cases may involve intravenous administration of
 theophylline, b2-agonists and magnesium sulphate. Both non-invasive and invasive ventilation
 may be options when medical treatment fails to prevent respiratory failure. It is important
 that relevant treatment algorithms exist, applicable to all levels of the treatment chain and
 reflecting local considerations and circumstances .

 Despite recent progress in the treatment of chronic asthma in childhood, acute exacerbations
 will continue to occur. Physicians working within the field of pediatric emergency medicine
 will therefore continue to be exposed to this clinical scenario. The cornerstones of acute
 asthma management in childhood remain rapid onset of oxygen treatment, inhalation of
 bronchodilators and systemic corticosteroids. Short-acting bronchodilators provide immediate
 relief of asthma symptoms and effects last four to six hours. The most commonly used
 short-acting bronchodilator for asthma is albuterol. These medications work quickly, and help
 to control symptoms of severe asthma attack. The doses as well as the way of delivery are
 important to reach the best bronchodilator effect. The amount of product that effectively
 reaches the bronchi is relatively small as 0.1% to 11%, respectively using a lung simulator .
 Despite this high variation of the amount of product delivery to the patient and the narrow
 limits of dose between benefice and side effects, the aerosolized route remained the
 preferred one even in severe cases .
Inclusion Criteria:

 -  Children aged 8-16 years.

 -  Patient with severe asthma (maximum expiratory flow <50%).

 -  Patient admitted to pediatric emergency.

 -  Patient who has agreed to participate, as well as the parents or legal guardian.

 Exclusion Criteria:

 Chronic respiratory failure, infectious disease, heart disease.

 -  Refusal to participate in the study.

 -  No affiliation to a social security scheme (beneficiary or beneficiary).

 -  Immediate intubation criteria