Nebulization Guidelines for Pediatric Patients with Acute Asthma in the ER

Recognition and Treatment of Acute Asthma

For pediatric patients with acute asthma exacerbations, the American Thoracic Society recommends immediate treatment with high-flow oxygen, nebulized salbutamol (5 mg or half dose in very young children), intravenous hydrocortisone, and addition of ipratropium (100 mg) nebulized every 6 hours 1, 2
The British Thoracic Society guidelines indicate that pediatric patients with acute severe asthma may present with symptoms such as being too breathless to talk or feed, respiratory rate >50 breaths/min, pulse >140 beats/min, and peak expiratory flow (PEF) <50% predicted (if measurable) 1

The American Academy of Pediatrics recommends providing high-flow oxygen via face mask and maintaining SaO₂ >92% 1
The American College of Chest Physicians suggests administering salbutamol 5 mg or terbutaline 10 mg via oxygen-driven nebulizer, with half doses used in very young children 1
The Society of Critical Care Medicine recommends giving intravenous hydrocortisone immediately, and for improving patients, switching to oral prednisolone 1-2 mg/kg daily (maximum 40 mg) 1, 2

The American Thoracic Society recommends repeating PEF measurement 15-30 minutes after starting treatment (if appropriate), monitoring oxygen saturation continuously to maintain SaO₂ >92%, and charting PEF before and after β-agonist administration and at least 4 times daily 1
Discharge criteria include patient having been on discharge medication for 24 hours, PEF >75% of predicted or best, and treatment plan including soluble steroid tablets and inhaled steroids in addition to bronchodilators 1