TABLE 2.
Medications and dosages for acute asthma treatment as per disease severity
| Asthma severity | Drug and route | Dose (maximum) | Risks | Comment |
|---|---|---|---|---|
| Mild | Inhaled corticosteroids | See discharge plan and Table 3 | ||
| Moderate* | Salbutamol, MDI with spacer | <20 kg = 5 puffs (0.1 mg/puff), >20 kg =10 puffs every 20 min during the first hour | Preferable route | |
| Salbutamol, intermittent nebulization | 5 mg in 2 ml of normal saline to be given every 20 min during the first hour | Monitor potassium serum levels in patients requiring frequent doses | ||
| Oral corticosteroids | Prednisone or prednisolone 1 to 2 mg/kg/day (maximum 60 mg) OR dexamethasone 0.15–0.3 mg/kg/day (maximum 10 mg) | Prolonged course or frequently repeated doses can be associated with adrenal suppression |
Start treatment early. Recommended as one single dose in the morning to decrease risk of adrenal suppression |
|
| Ipratropium bromide, MDI/spacer | Puffs (100 μg) every 20 min x 3 doses <20 kg = 3 puffs, >20 kg = 6 puffs | Use with caution in children with soy allergy | ||
| Severe† | Salbutamol, continuous nebulization | 0.3 mg/kg/hr 5 mg in 4 ml of normal saline | Tachycardia, hypokalemia, hyperglycemia | Monitor heart rhythm and rate, glucose and electrolytes |
| Ipratropium bromide, nebulized | <20 kg = 0.25 mg, >20 kg = 0.5 mg every 20 min maximum 3 doses | Can be mixed with salbutamol aerosols | ||
| IV corticosteroids | Methylprednisolone: 1–2 mg/kg/dose (maximum 60 mg q.6 h) hydrocortisone: 5–7 mg/kg (maximum 400 mg q.6 h) | |||
| Severe to impending respiratory failure | IV magnesium sulfate | 25–50 mg/kg IV bolus over 20 min (maximum 2 g) | Hypotension | Consider if patient is not improving |
| IV salbutamol | Load: 7.5 mcg/kg over 2–5 min, followed by 1 mcg/kg/min. Titrate upwards with increments of 1 mcg/kg/min (maximum 5 mcg/kg/min) | Tachycardia, hypokalemia, hyperglycemia | Monitor heart rhythm and rate, glucose and electrolytes |
*
Conventional treatment: Oral corticosteroids, nebulized salbutamol ± ipratropium;
†
Maximized treatment: intravenous (IV) steroids, continuous nebulized salbutamol + ipratropium. MDI metered-dose inhaler