1. PAEDIATRIC BREATHING DIFFICULTIES & COMMON CHEST PROBLEMS IN CHILDREN Dr. Shamanthakamani Narendran MD (pead), PhD (Yoga Science)

24. Treatment of acute asthma in children aged >2 years Thorax 2003; 58 (Suppl I): i1-i92 * Dose can be repeated every 20-30 minutes IV salbutamol (15 m g/kg) is effective adjunct in severe cases B Individualise drug dosing according to severity and adjust according to response B pMDI and spacer are preferred delivery system in mild to moderate asthma A Inhaled ß 2 agonists are first line treatment for acute asthma * A Use structured care protocols detailing bronchodilator usage, clinical assessment, and specific criteria for safe discharge D Children with life threatening asthma or SpO 2 <92% should receive high flow oxygen via a tight fitting face mask or nasal cannula at sufficient flow rates to achieve normal saturations 

26. Other therapies for acute asthma in children aged >2 years Thorax 2003; 58 (Suppl I): i1-i92 * Dose can be repeated every 20-30 minutes If poor response to  2 agonist treatment, add nebulised ipratropium bromide (250 mcg /dose mixed with  2 agonist) * A Aminophylline is not recommended in children with mild to moderate acute asthma A ECG monitoring is mandatory for all intravenous treatments  Consider aminophylline for children in high dependency/intensive care with severe or life threatening bronchospasm unresponsive to maximal doses of bronchodilators and steroid tablets C Do not give antibiotics routinely in the management of acute childhood asthma 

27. Hospital admission for acute asthma in children aged >2 years Thorax 2003; 58 (Suppl I): i1-i92 Consider intensive inpatient treatment for children with SpO 2 <92% on air after initial bronchodilator treatment B Decisions about admission should be made by trained physicians after repeated assessment of the response to further bronchodilator treatment  Transfer children with severe or life threatening asthma urgently to hospital to receive frequent doses of nebulised  2 agonists (2.5-5mg salbutamol or 5-10 mg terbutaline)  Children with acute asthma failing to improve after 10 puffs of  2 agonist should be referred to hospital. Further doses of bronchodilator should be given as necessary whilst awaiting transfer  Treat with oxygen and nebulised  2 agonists during the journey to hospital 

28. Treatment of acute asthma in children aged <2 years Thorax 2003; 58 (Suppl I): i1-i92 Oral  2 agonists are not recommended for acute asthma in infants B For mild to moderate acute asthma, a pMDI with spacer is the optimal drug delivery device A Consider inhaled ipratropium bromide in combination with an inhaled  2 agonist for more severe symptoms B Consider steroid tablets in infants early in the management of moderate to severe episodes of acute asthma in the hospital setting C Steroid tablet therapy (10 mg of soluble prednisolone for up to 3 days) is the preferred steroid preparation 