| Medications | Child Dosage | Adult Dosage | Comments |
| Inhaled short-acting beta2-agonists | |||
| Albuterol
Nebulizer solution (5 mg/mL) |
0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1 to 4 hours as needed, or 0.5 mg/kg/hour by continuous neb | 2.5 to 5 mg every 20 minutes for 3 doses, then 2.5 to 10 mg every 1-4 hours as needed or 10-15 mg/hour continuously | Only selective beta2-agonists are recommended. For optimal delivery, dilute aerosols to a minimum of 4 mL at gas flow of 6-8 L/min. |
| Albuterol
Metered-dose inhaler (90 mcg/kg/puff) |
4-8 puffs every 20 minutes up to 4 hours, then every 1-4 hours as needed. | 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed. | As effective as nebulized therapy if patient is able to coordinate inhalation maneuver. Use spacer/holding chamber. |
| Bitolterol and pirbuterol | Not studied in severe asthma exacerbations | ||
| Systemic (injected) beta2-agonists | |||
| Epinephrine
1:1000 (1 mg/mL) |
0.01 mg/kg up to 0.3 to 0.5 mg every 20 minutes for 3 doses SQ. | 0.3 to 0.5 mg every 20 minutes for 3 doses SQ | No proven advantage of systemic therapy over aerosol. |
| Terbutaline
(1 mg/mL) |
0.01 mg/kg every 20 minutes for 3 doses then every 2-6 hours as needed SQ. | 0.25 mg every 20 minutes for 3 doses SQ | No proven advantage of systemic therapy over aerosol. |
| Anticholinergics | |||
| Ipratropium bromide
Nebulizer solution (0.25 mg/mL) |
0.25 mg every 20 minutes for 3 doses, then every 2 to 4 hours as needed. | 0.5 mg every 30 minutes for 3 doses then every 2-4 hours as needed. | May mix in same nebulizer with albuterol. Should not be used as first-line therapy; should be added to beta2-agonist therapy. Dose delivered from MDI is low and has not been studied in asthma exacerbation. |
| Ipratropium bromide
Metered-dose inhaler (18 mcg/puff) |
4-8 puffs as needed | 4-8 puffs as needed | Dose delivered from MDI is low and has not been studied in acute exacerbation. |
| Steroids | |||
| Prednisone
Methylprednisolone Prednisolone |
1 mg/kg every 6 hours for 48 hours then 1-2 mg/kg/day (maximum = 60 mg/day) in 2 divided doses until PEF 70% of predicted or personal best | 120-180 mg/day in 3 or 4 divided doses for 48 hours, then 60-80 mg/day until PEF reaches 70% of predicted or personal best. | Child "burst" at discharge: 1-2 mg/kg/day maximum 60 mg/day for 3-10
days.
Adult "burst" at discharge:
|
This page is based on the Practical Guide for the Diagnosis and Management
of Asthma, a publication of the National Heart, Lung and Blood Institute
of the National Institutes of Health of the United States
NIH Publication No. 97-4053, October 1997
| Asthma |
| Pulmonology |
| NetScut |
