Asthma

Question 1

When would you use a nebuliser over salbutamol?

Answer 1

When a child needs concomitant oxygen therapy or when spacer therapy has failed - otherwise spacer therapy is preferred as it penetrates deeper into the lungs

Question 2

How do you administer salbutamol initially in moderate-severe asthma?

Answer 2

At LEAST 20 minutely in the first hour i.e. can also give every 10, 15 minutes or continuously

Question 3

What is the dose of paediatric salbutamol?

Answer 3

12 puffs in >/=6 years, 6 puffs in <6 years (if severe then 10mg neb in >/=6 years, 5mg neb in <6 years; if moderate then 5mg neb in >/=6 years, 2.5mg neb in <6 years)

Question 4

What is the dose of ipratropium?

Answer 4

8 puffs (500mcg neb) in >/=6 years, 4 puffs (250mcg neb) in <6 years. Every 20 minutes for the first hour (via spacer), then 4-6 hourly - cannot give more frequently due to risk of anticholinergic toxicity

Question 5

Why is early administration of steroids in severe asthma important?

Answer 5

Take hours to kick in. Aim is to use bronchodilators to keep child alive until the steroids start to work. Give within first hour (do not give in preschool children if mild/moderate wheezing responding to initial bronchodilators)

Question 6

What is the initial dose of prednisolone in asthma?

Answer 6

2mg/kg up to max 50mg (recently changed) (drop to 1mg/kg thereafter for 3-5 days)
If PO not possible then hydrocortisone 4mg/kg IV (max 100mg)

Question 7

What is the next step in the management of a child not improving with oxygen/bronchodilators/ipratropirum/steroids?

Answer 7

Commence IV therapy:

• prepare airway equipment and anaesthetic support
• obtain IV access
• consider IV agents: Mg sulfate preferred (in over 2 years). Alternative: aminophylline (cautions). Salbutamol is 3rd line (SEs)