Step 1 therapy for children 1 to 5 years
Many children aged 1 to 5 years don’t require acute treatment for their wheezing episodes as they are not bothersome (eg do not limit activity or affect sleep). For a recurrent bothersome wheeze associated with increased work of breathing, consider a trial of reliever therapy. Use the short-acting beta2 agonist (SABA) salbutamol (via a pressurised metered dose inhaler [pMDI]):
salbutamol 100 micrograms, 2 to 6 inhalations via pMDI with spacer (and face mask if required), as required. asthma or wheeze, Step 1 therapy (child 1 to 5 years) salbutamol
If symptoms do not show a clear response to correctly used salbutamol, the provisional diagnosis of asthma may be incorrect. Consider possible alternative diagnoses (see Alternative diagnoses that can be confused with asthma) and stop salbutamol therapy.
If symptoms do respond to the treatment trial of salbutamol, as-required salbutamol should continue to be used during episodes of bothersome wheezing. It is not necessary to use as-required salbutamol for isolated cough or for mild wheeze without increased work of breathing.
Educate parents and carers about how to use the pMDI, including advice about using a spacer (recommended for all children) and a mask (if required). See Inhalational drug delivery devices for information about using masks and spacers, and Summary of inhalational drug delivery devices for links to instructional videos and patient handouts for pMDIs.
Short-term as-required treatment with salbutamol is sufficient for most young children with wheeze. However, some children also require regular preventer therapy—see Step 2 therapy. Before escalating to Step 2 therapy, review inhaler technique and check equipment (inhaler, spacer, mask) for breakage or blockage. Also assess for symptoms and signs that indicate an alternative diagnosis or a comorbidity (eg rhinitis), and ensure exposure to triggers are minimised.