From the Guidelines
A salbutamol inhaler is suitable for a 3-year-old child with a severe acute asthmatic attack in the ER setting, with the preferred initial administration being via nebulizer at a dose of 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, as recommended by the most recent guidelines 1.
Key Considerations
- Salbutamol, a short-acting beta-2 agonist, provides rapid bronchodilation and symptom relief by relaxing the smooth muscles in the airways.
- For a 3-year-old, effective delivery to the lungs can be achieved via a metered-dose inhaler with an age-appropriate spacer device and mask, but nebulized salbutamol is preferred initially for severe attacks in the ER setting.
- The dosage for nebulized salbutamol in children is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then as needed, according to the guidelines 1.
- Systemic corticosteroids will also be necessary to address the underlying inflammation, as indicated by the viral trigger being a common cause of pediatric asthma exacerbations.
- Parents should be taught proper inhaler technique with the spacer and provided with a clear asthma action plan for home management after stabilization.
- Salbutamol is generally well-tolerated in children, with potential side effects including tremor, tachycardia, and irritability, as noted in clinical practice and guidelines 1.
Administration and Monitoring
- The initial treatment should include high flow oxygen via a face mask, as oxygen is beneficial in acute asthma exacerbations 1.
- The child's response to salbutamol and other treatments should be closely monitored, with adjustments made as necessary to ensure adequate control of symptoms and prevention of future exacerbations.
- The guidelines from the National Asthma Education and Prevention Program Expert Panel Report 3 provide a comprehensive approach to managing asthma exacerbations in the emergency department, including the use of salbutamol and other medications 1.
From the Research
Suitability of Salbutamol Inhaler for a 3-year-old Child with Severe Acute Asthmatic Attack
- The use of a salbutamol inhaler for a 3-year-old child with a severe acute asthmatic attack is supported by several studies 2, 3, 4, 5, 6.
- According to the study by 5, salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation.
- The study by 3 also found that administration of salbutamol and ipratropium bromide by a device of measured doses with a space chamber was more efficient than nebulization with supplementary oxygen for treating asthmatic crises in children.
- Another study by 4 recommends the use of short-acting, selective beta-2 agonists, such as salbutamol, delivered by intermittent nebulization, continuous nebulization, or by metered dose inhaler (MDI) with a spacer for the treatment of acute asthma in children.
- The study by 6 found that inhalation of budesonide suspension plus salbutamol and ipratropium bromide can effectively relieve asthmatic symptoms in children with good compliance and convenient administration.
Key Considerations
- The child's age and severity of the asthmatic attack should be taken into account when deciding on the treatment approach 2, 4.
- The use of a valved-holding chamber and mask with the inhaler can improve the delivery of the medication and increase its effectiveness 5.
- Combination therapy with ipratropium bromide and salbutamol may be more effective than salbutamol alone in severe asthma exacerbations 3, 5, 6.
- Oxygen saturation and clinical score should be monitored closely to assess the response to treatment and adjust the therapy as needed 5.