Table: Asthma Maintenance therapy in Children
SEVERITY OF ASTHMA |
TREATMENT |
Mild Intermittent associate mainly with respiratory infections |
Intermittent Treatment
Salbutamol (O) 0.15 mg/kg/day to the nearest 1 mg) in 2 to 4 divided doses
1 to 5 years: 1 to 2 mg four times a day
5 to 12 years: 2 to 4 mg four times a day
> 12 years: 4 mg four times a day
OR if available
Salbutamol inhaler intermittently |
Moderate Frequent, triggered by infection, allergy, exercise etc. |
Continuous Treatment
Salbutamol (O/Inhalation)as above
+/- Sodium cromoglycate Inhaler (if available) 1 mg (1 spincap) three to tour times a day. Dose may be increased to a maximum of 2 spincaps six times a day. |
Severe Persistent, persistent wheeze and/or failure to |
Add to the Above
Beclomethasone inhaler (50 micrograms/puff) 1 to 2 puffs three to four times a day respond to the above(always use a spacer)
OR
Prednisolone (O) 1 to 2 mg/kg/day initially, reducing to dose which controls the asthma; then attempt to give on alternative days (5 to 10 mg dose). |
NOTE Long term prednisolone in children should be avoided unless there is no alternative. |
Acute Attacks in Children
The same general measures apply as in adult. Give Several puffs of Salbutamol metered inhalation.
If poor response
Add
Adrenaline 1:1000 (SC) 0.01 ml/kg
OR
Aminophylline (slow IV) 4 mg/kg over 10 minutes. Do not give if oral aminophylline was given in the last 8 hours.
Unless response to the above is dramatic and complete, start:-
Prednisolone (O) 2 mg/kg/day in divided doses for 3-5 days. Severe
Acute Attack in children.
If response to the above therapy is inadequate, give
Dextrose 5% IV - 100 ml/kg/day
Plus
Aminophylline (IV infusion) at 0.8 - 1 mg/kg/hour
Plus
Hydrocortisone (IV) 2 mg/kg every 4 hours
Change to oral therapy when possible.
Prednisolone (O) 2 mg/kg/day for 5 days
Prophylaxis of asthma
Sodium cromoglycate is used in the prophylactic treatment of asthma including exercise-induced asthma. It should however, not be used for acute attacks of asthma as it has no effect on an established asthmatic attack. Sodium cromoglycate should be used regularly. When withdrawing treatment, the dose should be reduced gradually over a period of one week. Sodium cromoglycate should be used for at least 4 weeks before it can be proved as ineffective
