Pharmacology Notes

usually not necessary

if available-to maintain SaO2 above 94%

yes—to maintain SaO2 above 94%

1. salbutamol 100 micrograms MDI, 2–4 inhalations (preferably via a spacer) or 2.5 mg (<5 years) to 5 mg (>5 years) by nebuliser, 3- to 4-hourly

1. salbutamol 100 micrograms MDI, 6–12 inhalations (preferably via a spacer) or 5 mg by nebuliser (if initial response is inadequate, repeat every 20 minutes for 2 further doses, then 1- to 4-hourly thereafter)

1. salbutamol 5 mg by nebuliser driven by oxygen (at least 8 L/min) every 20 minutes for 3 doses or continuously

OR

OR

OR

1. terbutaline 500 micrograms DPI, 1-2 inhalations (>8 years) or 2.5 mg (<5 years) to 5 mg (>5 years) by nebuliser, 3- to 4-hourly

1. terbutaline 500 micrograms DPI, 2-4 inhalations (>8 years) or 5 mg by nebuliser (if initial response is inadequate, repeat every 20 minutes for 2 further doses, then 1- to 4-hourly thereafter)

1. terbutaline 5 mg by nebuliser driven by oxygen (at least 8 L/min) every 20 minutes for 3 doses or continuously

(optional, in addition to SABA)
ipratropium bromide 20 micrograms MDI, 1 inhalation (<5 years) or 2 inhalations (>5 years) (preferably via spacer) or 250 micrograms by nebuliser, 4-hourly

ipratropium bromide 250–500 micrograms by nebuliser driven by oxygen (at least 8 L/min) every 20 minutes for 3 doses then 4-hourly

for anaphylaxis or imminent cardiorespiratory arrest:
adrenaline 0.3 mg (0.3 mL of 1:1000 ampoule) diluted to 10 mL total volume slowly IV, or 0.3 mg (0.3 mL of 1:1000 ampoule) subcutaneously or via endotracheal tube

consider starting ICS or increasing them for a short time

prednisolone 1 mg/kg/day orally, to a maximum of 50 mg daily, for 3–5 days then cease abruptly without tapering

1. prednisolone 1 mg/kg/day orally, to a maximum of 50 mg daily, for 3–5 days then cease abruptly without tapering

OR

1. hydrocortisone 5 mg/kg (maximum 100 mg) IV, 6-hourly on day 1. The same dose of corticosteroid is usually given IV, 12-hourly on day 2, then reduced or converted to oral therapy (see moderate attack) as clinical state permits

OR

1. methylprednisolone 1 mg/kg (maximum 50 mg) IV, 6-hourly on day 1. The same dose of corticosteroid is usually given IV, 12-hourly on day 2, then reduced or converted to oral therapy (see moderate attack) as clinical state permits.

if no good response to initial treatment, give 25–100 mg/kg IV over 20 minutes

usually not necessary

often necessary

yes; consider ICU admission

? chest X-ray

· chest X-ray

· check for hypokalaemia

· may require assisted ventilation