2025 Volume 39 Issue 1 Pages 1-6
We present the case of a 7-year-old boy, with untreated mild-to-moderate persistent bronchial asthma since infancy. He was brought to his previous hospital with respiratory failure and impaired consciousness, and thereafter transferred to our hospital for intensive care. The parents initially refused consent for exclusive corticosteroid treatment; however, they consented after we explained that corticosteroids constitute essential life-saving treatment. Besides the systemic administration of steroids, we initiated ventilatory management under muscle relaxation with rocuronium, repeated inhalational procaterol administration, and continuous magnesium sulfate intravenous infusion. Although the parents had been hoping for early discontinuation of corticosteroid use, after daily patient education, they agreed that corticosteroid use was acceptable for only acute exacerbations. Eventually, however, they were regretful about the earlier nonuse of corticosteroids, and accepted corticosteroids despite the conflict. He was extubated on the 6th day, and transferred to the referring hospital, which was equipped with an outpatient allergy clinic, to enable long-term management. He continued to receive inhalational corticosteroids for the next 6 months, without acute exacerbations. Although a near-fatal bronchial asthma exacerbation can trigger corticosteroid acceptance, it is important to assuage the parents' feelings about corticosteroid therapy that is started without sufficient time to foster acceptance.
