In the ED management of pediatric acute asthma, what is a typical escalation step if initial therapy is ineffective?

• A. Discharge home.
• B. Continue current therapy without revision.
• C. Administer additional inhaled albuterol alone.
• D. Escalate therapy by adding systemic corticosteroids and consider further interventions.

Answer: (D)

When a child with an acute asthma flare in the ED does not respond to initial bronchodilator therapy, you escalate care by adding systemic corticosteroids and then assess for further interventions. Systemic steroids address the underlying airway inflammation and help improve airflow over hours, often reducing the need for prolonged bronchodilator use and decreasing the chance of hospitalization. This approach recognizes that while inhaled bronchodilators provide quick relief, they don’t treat the inflammatory component driving the flare. If the child’s status remains concerning after steroids, you expand management with additional measures such as continuous bronchodilator therapy, possible magnesium sulfate, careful oxygenation, and consideration of admission or higher-level care. Discharging home or continuing the same therapy without addressing inflammation would be inappropriate when the patient isn’t improving, and simply giving more inhaled albuterol alone may be insufficient for a significant exacerbation.