Is 2.5ml of salbutamol (albuterol) 2mg/5ml three times a day for 3 days an appropriate treatment for a 1-year-old child weighing 10kg with a cough?

Salbutamol for Cough in a 1-Year-Old Child: Not Recommended

Salbutamol (2.5ml of 2mg/5ml three times daily for 3 days) is not recommended for treating cough in a 1-year-old child weighing 10kg, as there is no evidence supporting its effectiveness for cough without wheezing or bronchospasm.

Evidence Against Using Salbutamol for Cough

Current guidelines strongly recommend against using bronchodilators such as salbutamol for cough in children unless there is clear evidence of bronchospasm or asthma:

• A systematic review found "no evidence to support using β2-agonists in children with acute cough and no evidence of airflow obstruction" 1
• The CHEST guidelines specifically state that asthma medications should not be used for cough unless other evidence of asthma is present 1
• Research shows that in wheezy infants with an atopic background, there was no significant beneficial effect of salbutamol on either clinical symptoms or pulmonary function 2

Appropriate Indications for Salbutamol in Children

Salbutamol is appropriate in specific clinical scenarios:

1. Upper respiratory tract infections with bronchospasm: In children with URI before age 6, nebulized salbutamol may be beneficial before general anesthesia to reduce perioperative respiratory adverse events 1

2. Acute severe asthma: Guidelines recommend salbutamol at doses of 5mg or 0.15mg/kg via nebulizer for acute severe asthma 1

Concerns with the Proposed Regimen

The proposed regimen raises several concerns:

• Inappropriate indication: Cough alone without wheezing is not an indication for salbutamol
• Dosing concerns: The proposed dose (2.5ml of 2mg/5ml = 1mg per dose) is relatively high for a 10kg child
• Safety issues: Unnecessary use of β2-agonists may lead to side effects including tachycardia, tremor, and potential paradoxical bronchospasm

Management Algorithm for Cough in a 1-Year-Old

1. Determine cough duration:

   • Acute cough (<4 weeks): Usually self-limiting viral infection
   • Chronic cough (>4 weeks): Requires further evaluation

2. Evaluate for specific cough pointers:

   • Wheezing or history of atopy (may suggest asthma)
   • Coughing with feeding (may suggest aspiration)
   • Wet/productive cough (may suggest protracted bacterial bronchitis)
   • GI symptoms (may suggest GERD, though GERD is not commonly identified as a cause of isolated cough in children) 1

3. For simple cough without specific pointers:

   • Avoid over-the-counter cough medications due to lack of efficacy and potential harm 1, 3
   • Supportive care (hydration, humidification)
   • Monitor for resolution or progression

Important Caveats

• The CHEST guidelines emphasize that "treatment(s) for GERD should NOT be used when there are no clinical features of gastroesophageal reflux" 1
• Similarly, asthma medications should not be used empirically for cough without evidence of asthma 1
• Over-the-counter cough medications have been associated with significant morbidity and even mortality in young children 3

In conclusion, for this 1-year-old child with cough, salbutamol should not be prescribed unless there is clear evidence of bronchospasm or asthma. Supportive care and monitoring for specific cough pointers would be the appropriate management approach.