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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Medications other than inhaled beta agonists for treatment of acute asthma exacerbations in children <12 years of age*[1]

Medications other than inhaled beta agonists for treatment of acute asthma exacerbations in children <12 years of age*[1]
Inhaled bronchodilator (anticholinergic)
Ipratropium bromide nebulizer solution
(250 micrograms/mL)
  • <20 kg – 250 mcg/dose
  • ≥20 kg – 500 mcg/dose
  • Every 20 minutes for 3 doses, then as needed. May combine with albuterol for intermittent or continuous nebulizer treatment.
Ipratropium bromide MDI with spacer
(18 micrograms/puff)
  • 4 to 8 puffs every 20 minutes as needed for up to 3 hours. Use VHC spacer; add mask in children <4 years. May give as combined MDI (18 micrograms ipratropium with 90 micrograms albuterol per puff).
Systemic glucocorticoids
Dexamethasone
  • 0.3 to 0.6 mg/kg (maximum 12 to 16 mg/day) by mouth, IM, or IV.
Prednisone or prednisolone
  • 1 to 2 mg/kg (maximum 60 mg/day) by mouth for the first dose, and then 0.5 to 1 mg/kg twice daily for subsequent doses starting the following day. A 3- to 10-day course is generally given.
Methylprednisolone
  • 1 to 2 mg/kg (maximum 125 mg/day) IV.
Systemic beta2-agonistsΔ
Epinephrine 1 mg/mL (also labeled 1:1000)
  • 0.01 mg/kg IM or SC if no evidence of anaphylaxis (maximum 0.4 mg/dose = 0.4 mL of 1 mg/mL solution). May be repeated every 10 minutes as needed until clinical improvement is demonstrated.
Terbutaline (1 mg/mL)
  • 0.01 mg/kg SC or IM (maximum 0.4 mg/dose = 0.4 mL of 1 mg/mL solution). May be repeated every 10 minutes as needed until clinical improvement is demonstrated or IV terbutaline is initiated.
  • May give IM or SC epinephrine OR terbutaline, but not both.
  • Initial IV bolus dose 10 micrograms/kg over 10 minutes, followed by a continuous infusion at 0.4 micrograms/kg/minute titrated up in increments of 0.1 to 0.5 micrograms/kg/min every 30 minutes until desired effect is achieved or adverse effects are observed. Usual dose range 0.4 to 2 micrograms/kg/minute. Typical maximum dose 3 to 5 micrograms/kg/minute.
Other treatment
Magnesium sulfate
  • Standard dose 50 mg/kg (0.2 mmol/kg) IV, with a range of 25 to 75 mg/kg IV (0.1 to 0.3 mmol/kg), given over 20 minutes (up to 2 grams approximately equal to 8 mmol)◊.

MDI: metered-dose inhaler; VHC: valved holding chamber; IV: intravenous; IM: intramuscular; SC: subcutaneous.

* Also refer to separate UpToDate topic reviews and table on recommended doses of beta agonist medications for treatment of acute asthma exacerbations in children <12 years of age.

¶ Useful formulations of prednisolone include concentrated oral liquids and orally disintegrating tablets (ODTs). For detail, refer to Lexicomp drug specific monograph included with UpToDate.

Δ Typically, subcutaneous or intramuscular epinephrine or terbutaline is reserved for patients who present to the emergency department with a severe exacerbation with markedly diminished aeration. Intravenous terbutaline is reserved for severely ill patients who are poorly responsive to conventional therapy. Alternative treatment options for these patients include noninvasive positive pressure ventilation and high-flow nasal cannula. Maximum doses of up to 10 micrograms/kg/minute have been described. However, in clinical practice, the maximum dose reached is limited by toxicities and is in the range of 2 to 3 micrograms/kg/minute. Systemic beta2-agonist treatment requires noninvasive cardiopulmonary monitoring, such as that available in a critical care setting. Orally administered systemic beta2-agonists are not recommended.

◊ Maximum dose of magnesium sulfate of up to 2.5 grams IV (approximately equal to 10 mmol) may be considered. Refer to UpToDate topics on emergency department management of acute asthma exacerbations in children, inpatient management of acute asthma exacerbations in children, and intensive care unit management of acute severe asthma exacerbations in children.[2]
References:
  1. Scarfone RJ, Fuchs SM, Nager AL, Shane SA. Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma. Pediatrics 1993; 92:513.
  2. Scarfone RJ, Loiselle JM, Joffe MD, et al. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med 2000; 36:572.

Courtesy of Richard Scarfone, MD, FAAP.

Additional data from: US Department of Health and Human Services. Expert panel report 3: Guidelines for the diagnosis and management of asthma. NIH Publication No. 07-4051. August 2007 available at https://www.ncbi.nlm.nih.gov/books/NBK7232/pdf/Bookshelf_NBK7232.pdf (accessed March 12, 2020).
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