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Home » , , , » Summary of treatment of acute attacks of asthma in children (Table 9.10)
Summary of treatment of acute attacks of asthma in children (Table 9.10)
Sunday, October 2, 2011 Posted by Piscean




Mild attack
Moderate attack
Severe attack
oxygen therapy
usually not necessary
if available-to maintain SaO2 above 94%
yes—to maintain SaO2 above 94%
short-acting beta2 agonists (SABA)
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
ipratropium bromide
(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
adrenaline
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
corticosteroids
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.
magnesium sulfate (IV)
if no good response to initial treatment, give 25–100 mg/kg IV over 20 minutes
hospital admission
usually not necessary
often necessary
yes; consider ICU admission
further management
? chest X-ray
 
· chest X-ray
· check for hypokalaemia
· may require assisted ventilation


ICS = inhaled corticosteroids; MDI = metered dose inhaler; DPI = dry powder inhaler; ICU = intensive care unit; SaO2 = oxygen saturation

Piscean

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