What is the best management approach for a 1-year-old patient with reactive airway disease, who responded to albuterol (short-acting beta-agonist (SABA)) in the emergency room, during a follow-up outpatient visit?

Management of 1-Year-Old Patient Following ER Visit for Reactive Airway Disease

For a 1-year-old patient following up after an emergency room visit for reactive airway disease who responded to albuterol, you should continue albuterol treatment as needed, assess symptom resolution, consider adding inhaled corticosteroids if symptoms persist, and arrange close follow-up within 1-4 weeks.

Initial Assessment at Follow-up Visit

• Evaluate current respiratory status: check for ongoing symptoms such as difficulty breathing, wheezing, coughing, or feeding difficulties 1
• Assess response to albuterol treatment received in the ER and any subsequent doses given at home 1
• Check vital signs, particularly respiratory rate (concerning if >50 breaths/min) and heart rate (concerning if >140 beats/min) 1, 2
• Perform physical examination focusing on respiratory effort, presence of wheezing, retractions, or other signs of respiratory distress 1

Treatment Plan

For Patients with Resolved Symptoms

• If symptoms have completely resolved and examination is normal:
  • Continue as-needed albuterol via age-appropriate delivery device (typically MDI with valved holding chamber and face mask for this age) 3, 4
  • Recommend dosing of 2-4 puffs every 4-6 hours as needed for recurrence of symptoms 3
  • Educate parents on proper inhaler technique and spacer use 1

For Patients with Persistent Symptoms

• If symptoms persist or examination shows ongoing respiratory distress:
  • Continue albuterol treatment with increased frequency (up to every 3-4 hours if needed) 1
  • Consider adding a short course of oral corticosteroids (prednisolone 1-2 mg/kg daily, maximum 40 mg) if moderate to severe symptoms persist 1
  • Consider initiating inhaled corticosteroids if this is a recurrent episode 1

Parent Education

• Provide clear instructions on recognizing worsening symptoms that require urgent medical attention 1:

  • Too breathless to talk or feed
  • Increased work of breathing
  • Respiratory rate >50 breaths/min
  • Cyanosis or marked pallor

• Teach proper medication administration techniques 1:

  • Demonstrate correct use of inhaler with spacer and face mask
  • Emphasize importance of completing full course of any prescribed steroids

Follow-up Planning

• Schedule follow-up appointment within 1 week if:

  • Symptoms were severe in the ER 1
  • Patient required multiple treatments 1
  • This is a recurrent episode 1

• Schedule routine follow-up within 4 weeks if:

  • Symptoms have resolved completely 1
  • This was a first episode 1

Special Considerations

• For very young children, albuterol delivery via MDI with spacer and face mask has been shown to be as effective as nebulizer treatment and is safe even with repeat dosing 4
• Be aware that some patients diagnosed with reactive airway disease may actually have other conditions - careful assessment is needed to confirm diagnosis 5
• If this is a recurrent episode, consider referral to a pediatric pulmonologist or allergist for further evaluation 1

Monitoring for Treatment Response

• Document baseline status and improvement with treatment 1
• Consider home monitoring plan for parents to track symptoms 1
• Ensure parents understand when to return for emergency care 1, 2