management of acute asthma in children

Question 1

order of drug administration

Answer 1

1. MILD ASTHMA
   1a. SABA via spacer
   1b. SABA via spacer + oral prednisilone
2. MODERATE ASTHMA
   2a. SABA via neb + prednisilone
   2b. SABA + ipratropium bromide via neb+ prednisilone

3 +4. SEVERE ASTHMA

3. IV salbutamol, IV aminophylline, IV magnesium (or neb), IV hydrocortisone
4. intubate and ventilate

Question 2

how do SABA and ipratropium bromide work together

Answer 2

synergy

work better in combination than in isolation

Question 3

how to decide what level of treatment to use

Answer 3

look at the patient

• RR
• work of breathing
• HR
• oxygen sats
• ability to complete sentences
• confusion
• air entry

Question 4

treatment approach to acute asthma

Answer 4

start treatment and review within the hour

step up/down as appropriate

Question 5

difference in steroid treatment between acute and chronic asthma

Answer 5

chronic/maintenance - INHALED

acute - ORAL