EDs meet criteria for persistent chronic asthma severity, yet prescriptions are not provided or patients are noncompliant with therapy Therefore, the ED visit for asthma represents an opportunity to improve outcomes for these children ASPIRATION PNEUMONIA CLINICAL PEARLS AND PITFALLS Aspiration pneumonitis refers to chemical injury and inflammation of lung tissue after inhalation of foreign material, whereas aspiration pneumonia refers to infection of lung tissue following pneumonitis Patients at risk for aspiration pneumonia include those with impaired neurologic status, technology dependence, oropharyngeal dysfunction, and gastrointestinal dysmotility Initial chest radiographs may be normal following aspiration episodes Treatment with antibiotics is generally reserved for patients with significant respiratory impairment and signs of infection or complicating medical history Treatment with corticosteroids is not routinely indicated Current Evidence Aspiration of foreign material into the lung can result in inflammation and impaired lung function Aspiration pneumonitis (also referred to as chemical pneumonitis) refers to chemical injury and inflammation of lung tissue from inhaled foreign material, with sterile acidic gastric contents being the most common source Aspiration pneumonia refers to infection of lung tissue following inhalation of foreign material, often due to bacteria from the oropharynx The pathophysiology of pulmonary disease following aspiration has been studied in animal models These studies have demonstrated that a relatively large volume acidic inoculum will induce pathologic changes within minutes including atelectasis, peribronchial hemorrhage, and pulmonary edema There is an appreciable inflammatory response on pathology with polymorphonuclear cells and fibrin along with hyaline membrane deposits These responses are mediated through multiple proinflammatory cytokines Aspiration of hydrocarbons is covered separately in Chapter 102 Toxicologic Emergencies