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Acute Asthma — RACP Paediatrics MCQ

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ModerateRespiratoryAcute AsthmaRACP Paediatrics

A 5-year-old boy with known asthma presents with an acute exacerbation. He has been given 6 puffs of salbutamol via spacer every 20 minutes for 3 doses with no improvement. His SpO2 is 90%, he has marked accessory muscle use and can only speak in single words. What is the next most appropriate step?

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Correct answer: A — Continuous nebulised salbutamol and ipratropium bromide, plus oral prednisolone 1 mg/kg

A child with a severe asthma exacerbation unresponsive to initial bronchodilator therapy requires escalation to continuous nebulised salbutamol with ipratropium bromide, systemic corticosteroids (oral prednisolone 1 mg/kg or IV hydrocortisone if unable to tolerate oral), and supplemental oxygen. IV magnesium sulfate and aminophylline are considered in life-threatening or near-fatal presentations.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Acute Asthma