Acute Asthma Management in a 5‑Year‑Old Child (≈12 kg)

Initial Treatment (First 3 Doses)

For a 5‑year‑old child weighing ~12 kg with an acute asthma exacerbation, give nebulized salbutamol 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for three consecutive doses; dilute in ≥3 mL saline and deliver with 6–8 L/min oxygen flow【1】【2】.
An equivalent press‑urized metered‑dose inhaler (MDI) regimen is 4–8 puffs (90 µg/puff) every 20 minutes for three doses using a spacer and facial mask; this is as effective as nebulization for mild‑to‑moderate attacks【1】【2】【3】.

Mild‑to‑moderate exacerbation: Continue salbutamol nebulization at 0.15–0.30 mg/kg (use 2.5 mg) every 1–4 hours as needed, or 4–8 MDI puffs every 1–4 hours PRN【1】【2】.
Severe exacerbation: Consider continuous nebulization at 0.5 mg/kg/h (≈6 mg/h for this child) and add ipratropium bromide 0.25–0.5 mg nebulized every 20 minutes for three doses; ipratropium may be mixed with salbutamol in the same nebulizer【1】【3】.

Oral prednisolone 1–2 mg/kg/day (maximum 60 mg/day) divided into two doses is recommended when there is no rapid bronchodilator response or if the child has used steroids recently【2】【3】.
A short course of 3–10 days is sufficient; tapering is unnecessary for courses shorter than one week【3】.

Do not reduce the dose below the minimum 2.5 mg even if weight‑based calculation is lower【1】【2】.
Initiate systemic corticosteroids early in moderate‑to‑severe exacerbations【1】【3】.
Ipratropium should always be combined with a short‑acting β₂‑agonist; it is not a first‑line monotherapy【3】.
Injectable β‑agonists have no proven benefit over aerosolized delivery【1】【2】.
Re‑evaluate clinical response after 60–90 minutes of therapy initiation【4】.

Use a well‑fitted facial mask covering nose and mouth for inhalation delivery【5】.
Avoid directing nebulized spray toward the eyes【5】.
Levalbuterol can be administered at half the salbutamol dose (0.075 mg/kg, minimum 1.25 mg) with comparable efficacy and safety【1】【2】【3】.