From the Guidelines
For a reactive airway disease exacerbation in an eight-year-old, start with a short-acting beta-agonist like albuterol via metered-dose inhaler with spacer (2-4 puffs every 4-6 hours as needed) or nebulizer (2.5 mg every 4-6 hours as needed), as recommended by the National Asthma Education and Prevention Program Expert Panel report 3 guidelines for the management of asthma exacerbations 1.
Treatment Approach
The primary treatment consists of administration of oxygen, inhaled beta2-agonists, and systemic corticosteroids, with the dose and frequency of administration dependent on the severity of the exacerbation 1.
- Inhaled short-acting beta2-agonists (SABA) such as albuterol can be administered via nebulizer solution (0.15 mg/kg, minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization 1.
- For moderate to severe symptoms, add oral corticosteroids such as prednisolone (1-2 mg/kg/day, maximum 60 mg daily for 3-5 days) to reduce the risk of recurrence 1.
Monitoring and Prevention
- Ensure the child stays well-hydrated and monitor their response to treatment, including work of breathing, oxygen saturation, and peak flow measurements if possible.
- If symptoms worsen despite treatment (increased work of breathing, decreased oxygen saturation below 92%, or inability to speak in complete sentences), seek emergency care immediately.
- For prevention of future exacerbations, consider maintenance therapy with inhaled corticosteroids like fluticasone (50-100 mcg twice daily) and identify/avoid triggers such as allergens, cold air, or exercise 1.
Key Considerations
- Teaching proper inhaler technique is essential for effective medication delivery to the lungs.
- The medications work by reducing airway inflammation and bronchospasm, which are the underlying mechanisms of reactive airway disease.
From the FDA Drug Label
Published reports of trials in asthmatic children aged 3 years or older have demonstrated significant improvement in either FEV1 or PEFR within 2 to 20 minutes following a single dose of albuterol inhalation solution An increase of 15% or more in baseline FEV1 has been observed in children aged 5 to 11 years up to 6 hours after treatment with doses of 0.10 mg/kg or higher of albuterol inhalation solution.
For an eight-year-old with reactive airway disease exacerbation, albuterol inhalation solution can be used. The recommended dose is 0.10 mg/kg or higher, which has been shown to produce a significant improvement in FEV1 or PEFR within 2 to 20 minutes. The effect can last up to 6 hours. It is essential to follow the recommended dosage and not exceed it without medical consultation 2.
From the Research
Treatment Options for Reactive Airway Disease Exacerbation
- The treatment of reactive airway disease exacerbation in an eight-year-old can be managed with metered-dose inhalers (MDIs) or nebulizers, with MDIs being a more effective option in some cases 3, 4, 5.
- A study published in 2019 found that salbutamol and ipratropium by MDI with a valved-holding chamber and mask was superior to nebulizer delivery in children with severe asthma exacerbations, resulting in a lower rate of hospital admission 3.
- Another study published in 2020 found that albuterol delivered through MDI with a spacer was associated with a significant reduction in the pulmonary index score and a smaller increase in heart rate compared to nebulizer delivery 4.
- A 2024 study found that MDI with a spacer was more effective than nebulizer treatment in reducing follow-up visits to the clinic and emergency department visits within 30 days 5.
Comparison of Delivery Methods
- A 1997 study compared the efficacy of inhaled albuterol delivered via jet nebulizer, MDI with spacer, or dry powder in adult asthmatics and found no significant differences in the bronchodilator response between the three delivery systems 6.
- A 2018 study compared the clinical efficacy of breath-actuated nebulizers and MDIs in treating pediatric patients with mild to moderate asthma exacerbations and found that MDI therapy was noninferior to breath-actuated nebulizer therapy 7.