Asthma - Acute Paediatric - 3 

Important Accurate assessment of severity is crucial for appropriate management - ask for help if you are unsure   

Management of acute asthma

Source : Asthma Management Handbook, 2006, National Asthma Council, Australia   

 asthma management

You can download the

National Asthma Council Asthma Management Hanbook

Use a metered dose inhaler (MDI) and spacer
Salbutamol administered via a MDI and spacer has been shown to be at least as effective as nebulised salbutamol in mild to moderate acute asthma.

Salbutamol nebulisers are still indicated in severe acute asthma.   

MDi and spacer

For young children
- use small volume spacer and face mask
- dose of 6 x 100mcg (equivalent to 2.5mg nebulised salbutamol)   
  For children > 6 years
- use large volume spacer.
- dose of 12 x 100mcg (equivalent to 5mg nebulised salbutamol)    

One dose at a time
The spacer should be loaded with one puff at a time, with 4 tidal breaths in between puffs.
This ensures the child is receiving the correct dose and that the chamber is being cleared correctly.    

MDI + spacer vs. nebuliser debate

The cost to the emergency department is probably equivalent.
The important points are:-
- the extra cost to society of the trip to the emergency department,
- the perception of [expensive] nebulisers as the mainstay of treatment of acute asthma reinforces the need for further nebulisers in future exacerbations.

The attendance at the emergency department should be used as an opportunity to educate.   

Link Cochrane collaboration on MDI vs Nebulisers

Link RCT of nebuliser vs MDI in 2-24 month old children: Arch Pediatr Adolesc Med 2003 Jan;157(1):76-80