Table 2.
Asthma Medications (Quick Relief) (43)
| MEDICATION | DOSING RECOMMENDATION | NOTES |
|---|---|---|
| INH Short-Acting β2-Agonists (to relax the smooth muscles; activates β2 adrenergic receptors in the lungs, resulting in bronchodilation) | ||
| Albuterol MDI (90 μg/puff; 200 puffs/canister) | Preexercise dosing: 2 puffs INH 15 min before exercise | Indicated for quick relief of bronchospasm or to prevent bronchospasm related to exercise |
| For single dose (yellow zone management on AAP): 2–4 puffs INH every 4–6 h as needed for symptoms | Adverse effects include tachycardia and tachypnea | |
| For acute exacerbation (red zone management on AAP): 4–8 puffs every 20 min × 3 doses: | ||
| ≥5 to <10 kg: 4 puffs INH every 20 min for 3 doses | ||
| ≥10 to <30 kg: 6 puffs INH every 20 min for 3 doses | ||
| ≥30 kg: 8 puffs INH every 20 min for 3 doses | ||
| Albuterol inhalation solution (0.63 mg/3 mL, 1.25 mg/3 mL, 2.5 mg/3 mL, or 5 mg/mL) | ≥5 to <30 kg: 2.5-mg neb INH for single dose OR 7.5-mg neb INH for 1 h | |
| ≥30 kg: 5-mg neb INH for single dose OR 15-mg neb INH for 1 h | ||
| If still wheezing and in distress after 2 h of short-acting β2-agonist, consider continuous neb treatment (0.6 mg/kg per hour): | ||
| ≥5 to <10 kg: 5-mg/h neb INH every 1 h | ||
| ≥10 to <20 kg: 10-mg/h neb INH every 1 h | ||
| ≥20 to <30 kg: 15-mg/h neb INH every 1 h | ||
| ≥30 kg: 20-mg/h neb INH every 1 h | ||
| Anticholinergics (antimuscarinic agent [blocks action of acetylcholine], which results in decreased contractility of smooth muscle resulting in bronchodilation) | ||
| Ipratropium bromide inhalation solution (0.25 mg/mL) | 0.25–0.5 mg neb INH every 20 min for 3 doses | Indicated in the ED setting for moderate to severe exacerbation |
| ≥5 to <30 kg: 0.5 mg neb INH once | Can cause transient dilation of the pupil(s) and blurry vision if neb formulation is blown into the eyes for a prolonged period | |
| 30 kg: 1 mg neb INH once | ||
| Ipatropium bromide MDI (18 μg/puff) | 4–8 puffs every 20 min INH for 3 doses | |
| Systemic Corticosteroids (anti-inflammatory; reverses B2-receptor downregulation) | ||
| Dexamethasone | Short course (burst): | Indicated for treatment of moderate to severe exacerbations |
| ≥7 to <10 kg: 6 mg PO once with repeat dose in 24 h | ||
| ≥10 to <20 kg: 10 mg PO once with repeat dose in 24 h | ||
| ≥30 kg: 16 mg PO once with repeat dose in 24 h | ||
| OR 0.6 mg/kg IV or IM (max, 16 mg) in children not tolerating oral medications | ||
| Prednisone (1-, 2.5-, 5-, 10-, 20-, and 50-mg tablets) | Short course (burst): 1–2 mg/kg per day PO (max, 60 mg) for 3–10 d divided twice daily | Consider comorbidities, eg, studies show patients with sickle cell disease and asthma have rebound acute chest syndrome with systemic corticosteroids and, hence, should be avoided (64) |
| Prednisolone (5 mg/5 mL or 15 mg/5 mL) | Short course (burst): 1–2 mg/kg per day PO (max, 60 mg) for 3–10 d divided twice daily | Will raise serum glucose so use with caution in diabetes |
| Methylprednisolone | Short course (burst): 1–2 mg/kg per day IV (max, 60 mg) for 3–10 d divided every 6–12 h | |
| Adjunct acute asthma medications | ||
| Magnesium sulfate | 50 mg/kg per dose (max, 2,000 mg/dose) IV once over 20 min | Consider after 1 h of short-acting β2-agonists and after systemic corticosteroids if still with respiratory distress and wheezing |
| Epinephrine (1:1,000) (1 mg/mL) | 0.01 mg/kg per dose (max, 0.5 mg/dose) IM once | Consider in severe, life-threatening asthma |
AAP=asthma action plan, ED=emergency department, h=hour, INH=inhaled, IM=intramuscular, IV=intravenous, max=maximum, MDI=metered-dose inhaler, neb=nebulized, PO=‘per os’ or by mouth.