A> Bronchial Asthma in Acute Exacerbation

P>DIET: NPO if with DOB

LABS: CBc w/ PC (if with URTI), Chest x-ray PA
MEDS:
At the clinic:
1. O2 supplement (Target: Adult >=93%, Pedia >= 94%)

2. Salbutamol + Ipratropium nebule, 1 nebule 15 minutes apart for 3 doses

3. Prednisolone: Adults: 1mg/kg/DAY max:50mg ; Pedia: 1-2mg/kg/DAY max:40mg

Take home medication:

1. Salbutamol + Ipratropium nebule, 1 nebule every 8 hours as needed for difficulty
of breathing

2. Salbutamol syrup 2mg/5ml, give ?ml three times a day or every 8 hours (0.1-
0.5mkd TID)
Salbutamol 1mg + Guaifenasin 50mg/5ml syrup, give 5 OR 10ml three times a day or
every 8 hours (2-6 yrs old)
Salbutamol 1mg + Guaifenasin 50mg/5ml syrup, give 10ml three times a day or every 8
hours (7-12 yrs old and elderly
Salbutamol 2mg + Guaifenasin 100mg/capsule, take 1 capsule three times a day or
every 8 hours (>12 yrs old and adults)

3. Prednisolone
Prednisolone syrup 1mg/ml, take ?ml twice a day with meals for 3-5 days (Pedia)
Prednisolone syrup 15m/5ml, take ?ml twice a day with meals for 5-7 days (Adults)
Prednisolone syrup 20mg/5ml, take ?ml twice a day with meals for 5-7 days (Adults)
Prednisolone 5mg/tablet, take 1 tablet twice a day with meals for 5-7 days (Adults)
Prednisolone 20mg/tablet, take 1 tablet twice a day with meals for 5-7 days
(Adults)

4. MONTELUKAST (CI <2yrs old)

Montelukast chewable 4mg/tablet, give 1 tablet once a day before bedtime (2-5 yrs
old)
Montelukast chewable 5mg/tablet, give 1 tablet once a day before bedtime (6-14 yrs
old)
Montelukast 10mg/tablet, take 1 tablet once a day before bedtime (>15 yrs old)

5. Metered Dose Inhaler:

Salbutamol 100mcg MDI, 1 puff as needed for difficulty of breathing, maximum: 4
times daily (CHILD)
Salbutamol 100mcg MDI, 1-2 puffs as needed for difficulty of breathing, maximum: 4
times daily (ADULT)
Salbutamol 100mcg MDI, 2 puffs 10 to 15 minutes before activity as prophylaxis

6. Salmeterol + Fluticasone (Seretide) 25/50 MDI, 2 puffs twice a day or every 12

hours as maintenance (>=4 yrs old)
Salmeterol + Fluticasone (Seretide) 25/50, 25/125, 25/250 MDI, 2 puffs twice a day
or every 12 hours as maintenance (>=12 yrs old and ADULT)

7. Budesonide + Formoterol (Symbicort) 160/4.5mcg, 1-2 puffs twice a day or every

12 hours for relief of DOB
Budesonide + Formoterol (Symbicort) 160/4.5mcg, 2 puffs twice a day or every 12
hours for maintenance
Budesonide + Formoterol (Symbicort) 320/9mcg, 1 puff twice a day or every 12 hours
(COPD)
8. Allergic Rhinitis Intranasal Steroids
Budesonide nasal spray 64mcg, 1 spray per nostril twice a day or every 12 hours (>6
yrs old)
Fluticasone nasal spray, 1 spray per nostril once a day (2-11 yrs old)
Fluticasone nasal spray, 2 sprays per nostril once a day (>12 yrs old to ADULT)
Fluticasone nasal spray, 1 spray per nostril once a day for maintenance (>12 yrs
old to ADULT)
ADVISE: Moderate to Severe exacerbation - Refer to hospital; Avoid allergens and
triggers; WOF: recurrence and worsening of symptoms
FOLLOW UP: once with results or as needed