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Recomendación 1:
En niños y adolescentes con crisis asmática leve, moderada o severa, se recomienda utilizar inhaladores de dosis medida con espaciador en lugar de nebulización para administrar agonistas beta-2 de acción corta, debido a sus beneficios en la reducción de la dosis requerida y menores efectos secundarios. (Recomendación fuerte a favor, certeza moderada de la evidencia)

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Recomendación 1:
En niños y adolescentes con crisis asmática, se sugiere el uso de corticoides inhalados como primera opción en lugar de corticoides sistémicos debido a un perfil de seguridad mejor y efectos secundarios reducidos. (Recomendación condicional a favor, certeza baja de la evidencia)

BPC 1:
En pacientes pediátricos con crisis asmática leve a moderada, el uso de corticoides inhalados debe ser acompañado de educación a los padres y cuidadores sobre la importancia de adherirse al tratamiento preventivo y monitorear posibles efectos adversos.

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Recomendación 1:
En niños y adolescentes con crisis asmática moderada o severa, se sugiere añadir anticolinérgicos (bromuro de ipratropio) a los agonistas beta-2 de acción corta para reducir el riesgo de hospitalización y mejorar los desenlaces clínicos. (Recomendación condicional a favor, certeza moderada de la evidencia)

BPC 1:
La adición de bromuro de ipratropio está indicada principalmente en el contexto de crisis asmáticas graves que no responden adecuadamente a los agonistas beta-2 solos.

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Recomendación 1:
En niños y adolescentes con crisis asmática severa, se recomienda considerar el uso de sulfato de magnesio intravenoso como tratamiento complementario en aquellos que no responden al tratamiento inicial con agonistas beta-2 y anticolinérgicos. (Recomendación condicional a favor, certeza baja de la evidencia)

BPC 1:
El sulfato de magnesio debe ser administrado solo en el entorno hospitalario, bajo la supervisión de personal especializado, y después de una evaluación clínica cuidadosa para identificar los pacientes que podrían beneficiarse más del tratamiento.

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Recomendación 1:
En niños y adolescentes con crisis asmática severa que no responden al tratamiento inicial, se recomienda la administración de sulfato de magnesio endovenoso como parte del manejo en el departamento de emergencia para reducir la necesidad de hospitalización y mejorar la función pulmonar. (Recomendación fuerte a favor, certeza moderada de la evidencia)

BPC 1:
La administración de sulfato de magnesio debe ser considerada después de evaluar la respuesta del paciente a los tratamientos iniciales, teniendo en cuenta factores como la gravedad de la crisis y la disponibilidad de recursos.

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Recomendación 1:
En niños y adolescentes con crisis asmática, se recomienda brindar intervenciones educativas basadas en el autocontrol del asma al alta del departamento de emergencia, con el objetivo de reducir las hospitalizaciones y visitas posteriores al servicio de emergencia. (Recomendación condicional a favor, certeza moderada de la evidencia)

BPC 1:
Las intervenciones educativas deben incluir planes individualizados para los pacientes y sus familias, asegurando que comprendan el manejo del asma, la importancia del uso adecuado de medicamentos preventivos y las acciones a tomar ante una exacerbación.

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