Asthma Medication

Supplemental oxygen if SpO2 is less than 92, aiming for SpO2 of 92-96%

Bronchodilator therapy
Children (1 to 5):
Salbutamol 100mcg, 6 puffs via MDI with spacer every 20 minutes for first hour (or sooner if needed)
PLUS
Ipratropium 21mcg, 4 puffs via MDI every 20 minutes for first hour (or sooner if needed)

Children (6+) and adults:

Salbutamol 100mcg, 12 puffs via MDI with spacer every 20 minutes for first hour (or sooner if needed)
PLUS
Iptratroium 21mcg, 8 puffs via MDI every 20 minutes for first hour (or sooner if needed)

If patient can’t breathe through spacer:

Children (1 to 5)
Salbutamol 2.5mg via intermittent nebulisation every 20 minutes for the first hour (or sooner if
needed)
PLUS
Ipratroium 250mcg via intermittent nebulisation every 20 minutes for the first hour (or sooner if
needed)

Children (6+) and adults:

Salbutamol 5mg via intermittent nebulisation every 20 minutes for the first hour (or sooner if needed)
PLUS
Ipratroium 500mcg via intermittent nebulisation every 20 minutes for the first hour (or sooner if
needed)

Salbutamol:
- With ipratroprium can precipitate acute angle closure crisis (rare)
- Oral: cardiovascular, hyperthyroidism (CVS SE), diabetes (hyperglycemia),
- Elderly (lower dose than normal adult dose then increase)
- Pregnancy and breastfeeding: safe to use

Ipratroprium:
- With salbutamol can precipitate acute angle closure crisis (rare)
- Patients with cardiovascular disorders
- Can worsen bladder outlet obstruction symptoms
- Pregnancy and breastfeeding: safe to use

Precautions

Prednisone
- Careful use: latent tuberculosis, adrenal suppression, PUD, DM, HTN, CRF, psychiatric
disorders, recurrent infections, glaucoma, osteoporosis, myasthenia gravis,
phaemochromocytoma
- Surgery: wound healing
- Children: not chronically (growth retardation)
- Pregnancy: lowest possible dose for shortest possible time

Dexamethasone:
- Same as prednisone
Hydrocortisone:
- Same as prednisone
- Preferred for maternal disorders as placental transfer is limited

Methylprednisolone:
- Same as prednisone
- Preferred for maternal disorders as placental transfer is limited

Interactions:
Salbutamol interactions:
- sympathomimetic amines: compound adverse effects e.g. tremor, tachycardia
- combined beta blockers and beta agonists: can precipitate asthma
- theophylline: can cause hypokalemia
- general potentiation of drugs causing hypokalemia and hyperglycemia

Ipratrorium interactions:
- salbutamol (acute angle closure crisis)
- when combined with other anticholinergics, can potentiate effects