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Question 7:

In the child with an asthma exacerbation in the ED, should heliox-driven albuterol vs. standard albuterol therapy be used to prevent hospitalization, to decrease time in the ED, and/or to improve pulmonary function?

Asthma team recommendation: We recommend that heliox-driven albuterol be considered for patients who have life-threatening asthma exacerbations or for those who remain in the severe category after 1 hour of intensive therapy. The recommendation is based on agreement with the EPR-3 (2007) recommendation and two moderate quality papers. This recommendation may be applied to patients in most circumstances. Further research (if performed) is likely to have an important effect on our confidence in the estimate of effect and may change the estimate.

Literature supporting this recommendation: Literature was searched since the publication of EPR-3, 2007. Two citations were found from the search and both addressed the question. One of these was a Cochrane Collaborative meta-analysis (Rodrigo, 2010), the other was a randomized control trial reported by Bigham (2010). Both are of moderate quality.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.