Bronchodilator therapy

Start immediate treatment with nebulised salbutamol and ipratropium. Use oxygen to drive the nebuliser.

For bronchodilator therapy in a child 1 to 5 years old with life-threatening acute asthma, use:

salbutamol 2.5 mg at a time via continuous nebulisation asthma, acute: life-threatening (child 1 to 5 years) salbutamol

PLUS

ipratropium 250 micrograms added to nebulised solution every 20 minutes for the first hour. asthma, acute: life-threatening (child 1 to 5 years) ipratropium

For an adult or child 6 years or older, use:

salbutamol 10 mg at a time via continuous nebulisation asthma, acute: life-threatening (adult, child 6 years or older) salbutamol

PLUS

ipratropium 500 micrograms added to nebulised solution every 20 minutes for the first hour. asthma, acute: life-threatening (adult, child 6 years or older) ipratropium

Hypokalaemia and hypomagnesaemia are likely with repeated high doses of salbutamol—anticipate and manage early. Cardiovascular effects (eg myocardial ischaemia, prolonged QT interval predisposing to arrhythmias) can also occur.

If the patient shows a marked improvement with initial treatment, consider switching delivery of bronchodilator therapy to intermittent nebulisation or pMDI with spacer. For doses, see Treatment of severe acute asthma.

If severe or life-threatening acute asthma persists after starting treatment, give intravenous magnesium sulfate.