There are a number of severe medical conditions that are considered very serious and can cause concern for doctors. Some diseases are not extremely dangerous for adults, but when they occur in children and adolescents, additional measures and treatments are required since children’s bodies are much weaker. One such condition is pediatric asthma, and strenuous efforts are needed to decrease hospital admissions and mortality rates. As asthma is an extremely severe condition, especially for children, it may cause a number of serious complications (Papadopoulos et al., 2019). It may happen because of uncommon allergens or delayed treatment; that is why it is of vital importance for parents to pay attention to any symptoms their children may show. Therefore, appropriate care is necessary due to the high prevalence of the condition among children and related life-threatening risks. The objective of this research proposal is to evaluate the effectiveness of Inhaled ß2 agonists in the management of asthma in children.
The Spirit of Iniquity Ignited
There is a dearth of literature regarding the use of short-acting ß2 agonists in the management of acute pediatric asthma. Additionally, there is no consistent evidence supporting the use of intravenous short-acting ß2 agonists in patients with acute asthma. Therefore, the proposed study seeks to fill this literature gap by reviewing existing data on the effectiveness of ß2 agonists in managing pediatric asthma.
Formulation of PICOT Question
A PICOT question will be formulated to create the research query and enable the literature search. PICOT is an acronym for population, intervention, comparison, outcome, and time. The research study will be guided by the following research question: how effective are ß2 agonists in reducing hospitalization in children with asthma. The following table shows the proposed study’s PICOT question:
Population or patient
|Paediatric asthma||ß2 agonists||Those who did not receive ß2 agonists||Reduced hospitalizations||Within one-year|
PICOT question: Children with asthma who received ß2 agonists are more likely to experience reduced hospitalization compared to children who did not receive ß2 agonists within a period of one year.
A literature search will be conducted using Medline, the database, and Cochrane. Suitable keywords such as children with asthma, hospitalization of children with asthma, ß2 agonists, and asthma hospitalization among children will be used to identify and retrieve studies published from 2010 onwards that studied children aged 2 years and above. Inclusion and exclusion criteria will then be developed to select the studies relevant to the prosed research. The selected studies will be assessed and chosen according to methodology and relevance.
Critical Appraisal of Evidence
Since the proposed research will use a systematic review to evaluate the quality of evidence, primary studies that utilized quantitative and mixed-methods study designs will be assessed. Additionally, the internal and external validities of the reviewed studies will be considered to ensure that only quality ones are reviewed. The likelihood of bias in the data that is to be reviewed will be eliminated by using the Cochrane tool that enables researchers to identify high-quality research studies. The quality of evidence will be assessed based on six categories: inconsistency, risk of bias, imprecision, indirectness, publication bias, and any other criteria (Indinnimeo et al., 2018). The quality of studies will be upgraded on downgraded using magnitude factors, or limitations in the above-mentioned categories. Finally, the quality of evidence will be marked as very low, low, moderate, or high. Only high-quality evidence will be included in the systematic review.
Integration of Evidence with Clinical Expertise
Inhaled short-acting ß2 agonists are the first line of action for acute pediatric asthma (Indinnimeo et al., 2018). Salbutamol is the most common medication that can be prescribed to children of all ages. Inhalation through the nose is the traditional route of administration. However, studies have found that salbutamol administered continuously through a nebulizer is not associated with better outcomes in relation to frequent intermittent administration (Tesse, Borrelli & Mongelli, 2018). Additional studies that explored it showed that metered-dose inhalers with spacers is the most effective option for administering ß2 agonists in children with mild to moderate asthma (Indinnimeo et al., 2018).
The administration of salbutamol through a metered-dose inhaler should be adapted based on the severity of the attack. A dose of 200–400 μg/dose is considered sufficient during mild attacks. On the other hand, children with severe attacks should get frequent doses of nebulized salbutamol, driven by oxygen due to the danger of oxygen desaturation when using an air-driven compressor (Arulparithi et al., 2015). Once the symptoms have improved, the patients should be switched to a metered-dose inhaler with a spacer.
The Outcome of Practice Change Evaluated
The outcome change that will be evaluated in the study is whether ß2 agonists are more effective compared to other medications such as ipratropium bromide, which induces a slower bronchodilator reaction. Nonetheless, a combination of the two medications may induce a synergistic effect. During a severe attack, the optional dose is 125-250 μg/dose in children aged above four years with nebulized salbutamol (Hughes et al., 2017). The medications should be given regularly, up to three times every half an hour during the first hour. Subsequently, the ipratropium dose is tapered to 4 to 6 hourly or stopped. Clinical trials support the use of ipratropium in combination with salbutamol since anticholinergics alone may lead to treatment failure (Indinnime et al., 2018). Therefore, the use of anticholinergics alone in the treatment of acute pediatric asthma is not effective. Other studies have shown that the use of anticholinergics combined with SABAS significantly lowered the risk of hospitalizations in children with asthma. A small number of children treated using anticholinergics in combination with short-acting ß2 agonists have reported side effects such as nausea and tremors as compared to ß2 agonists alone. These findings support the conclusion that administering anticholinergics in addition to ß2 agonists is effective in lowering hospitalizations among children with moderate to severe asthma.
The findings of the study will be disseminated through a guideline on the management of acute pediatric asthma in ambulatory and emergency care settings. The guideline will be issued to members of professional associations such as the American Pediatric Association.
Pediatric asthma is one of the causes of emergency department appointments and hospitalizations. Suitable care is necessary due to the prevalence of the condition in children and the related risk. The proposed study will assess the effectiveness of ß2 agonists in the management of pediatric asthma. Existing literature supports the use of salbutamol in managing moderate to severe asthma in children. Salbutamol is one of the most common ß2 agonists, and its effectiveness can be enhanced by using it in combination with anticholinergics. However, there is limited literature that shows its effectiveness in managing pediatric asthma. The proposed study will use a systemic review to assess the evidence that shows the use of ß2 agonists. The findings of the study will be disseminated through a guideline that will be issued to professional associations to guide clinical practice. Since the findings will be evidence-based, they will inform the clinical management of pediatric asthma to reduce the risk of hospitalizations.
Arulparithi, C.S., Babu, T.A, & Ravichandran, C, et al. (2015). Efficacy of nebulised budesonide versus oral prednisolone in acute severe asthma. Indian J Pediatr; 82:328–32. Web.
Indinnimeo, L., Chiappini, E., & del Giudice, M et al. (2018). Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics. Italian Journal of Pediatrics, 44(46). Web.
Papadopoulos, N. G., Čustović, A., Cabana, M. D., Dell, S. D., Deschildre, A., Hedlin, G., & Price, D. B. (2019). Pediatric asthma: An unmet need for more effective, focused treatments. Pediatric Allergy and Immunology, 30(1), 7-16. Web.
Hughes, H. K., Matsui, E. C., Tschudy, M. M., Pollack, C. E., & Keet, C. A. (2017). Pediatric asthma health disparities: Race, hardship, housing, and asthma in a national survey. Academic pediatrics, 17(2), 127-134. Web.
Tesse, R., Borrelli, G., & Mongelli, G. (2018). Treating pediatric asthma according guidelines. Front Pediatr; 6: 234. Web.