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2. Respiratory diseases
Treatment
T reatm ent and follow -up d epend on th e sev erity of th e attack and th e patient‟s response:
Mild to moderate attack
– R eassure th e patient; place h im in a 1 / 2 sitting position. 2
– A d m inister:
• salbutamol (aerosol): 2 to 4 puffs ev ery 2 0 to 3 0 m inutes, up to 1 0 puffs if necessary
d uring th e first h our. I n ch ild ren, use a space1r to ease ad m inistration ( use face
m ask in ch ild ren und er 3 years). Sing le puffs sh ould be g iv en one at a tim e, let th e
ch ild breath e 4 to 5 tim es from th e spacer before repeating th e proced ure.
• prednisolone P O : one d ose of 1 to 2 m g / kg
– If th e attack is com pletely resolv ed : observ e th e patient for 1 h our (4 h ours if h e liv es
far from th e h ealth centre) th en g iv e outpatient treatm ent: salbutam ol for 2 4 to
4 8 h ours ( 2 to 4 puffs ev ery 4 to 6 h ours d epend ing on clinical ev olution) and
pred nisolone P O (1 to 2 m g / kg once d aily) to com plete 3 d ays of treatm ent.
– If th e attack is only partially resolv ed : continue w ith 2 to 4 puffs of salbutam ol ev ery
3 to 4 h ours if th e attack is m ild ; 6 puffs ev ery 1 to 2 h ours if th e attack is m od erate,
until sym ptom s subsid e, th en w h en th e attack is com pletely resolv ed , proceed as
abov e.
– If sym ptom s w orsen or d o not im prov e, treat as severe attack.
Severe attack
– H ospitalise th e patient; place h im in a 1 / 2 sitting position.
– A d m inister:
• oxygen continuously, at least 5 litres/ m inute or m aintain th e2O saturation betw een
9 4 and 9 8 % .
• salbutamol (aerosol): 2 to 4 puffs ev ery 2 0 to 3 0 m inutes, up to 1 0 puffs if necessary
in ch ild ren und er 5 years, up to 2 0 puffs in ch ild ren ov er 5 years and ad ults. U se a
spacer to increase effectiv eness, irrespectiv e of ag e.
or salbutam ol (solution for nebulisation), see follow ing pag e.
• prednisolone P O : one d ose of 1 to 2 m g / kg
In th e case of v om iting , use hydrocortisone IV ev ery 6 h ours (ch ild ren:
5 m g / kg / injection,
ad ults: 1 0 0 m g / injection) until th e patient can tolerate oral pred nisolone.
– If th e attack is com pletely resolv ed , observ e th e patient for at least 4 h ours. C ontinue
th e treatm ent w ith salbutam ol for 2 4 to 4 8 h ours ( 2 to 4 puffs ev ery 4 h ours) and
pred nisolone P O (1 to 2 m g / kg once d aily) to com plete 3 d ays of treatm ent.
R eassess after 1 0 d ays: consid er long -term treatm ent if th e asth m a attacks h av e
been
occurring for sev eral m onth s. If th e patient is alread y receiv ing long -term treatm ent,
reassess th e sev erity of th e asth m a (see table, pag e 7 7 ) and rev iew com pliance and
correct use of m ed ication and ad just treatm ent if necessary.
– If sym ptom s w orsen or d o not im prov e, see life-threatening attack.
If a conventional spacer is not available, use a 500 ml plastic bottle: insert the mouthpiece of the inhaler into a hole
1
made in the bottom of the bottle (the seal should be as tight as possible). The child breathes from the mouth of the
bottle in the same way as he would with a spacer. The use of a plastic cup instead of a spacer is not recommended
(ineffective).
75
Treatment
T reatm ent and follow -up d epend on th e sev erity of th e attack and th e patient‟s response:
Mild to moderate attack
– R eassure th e patient; place h im in a 1 / 2 sitting position. 2
– A d m inister:
• salbutamol (aerosol): 2 to 4 puffs ev ery 2 0 to 3 0 m inutes, up to 1 0 puffs if necessary
d uring th e first h our. I n ch ild ren, use a space1r to ease ad m inistration ( use face
m ask in ch ild ren und er 3 years). Sing le puffs sh ould be g iv en one at a tim e, let th e
ch ild breath e 4 to 5 tim es from th e spacer before repeating th e proced ure.
• prednisolone P O : one d ose of 1 to 2 m g / kg
– If th e attack is com pletely resolv ed : observ e th e patient for 1 h our (4 h ours if h e liv es
far from th e h ealth centre) th en g iv e outpatient treatm ent: salbutam ol for 2 4 to
4 8 h ours ( 2 to 4 puffs ev ery 4 to 6 h ours d epend ing on clinical ev olution) and
pred nisolone P O (1 to 2 m g / kg once d aily) to com plete 3 d ays of treatm ent.
– If th e attack is only partially resolv ed : continue w ith 2 to 4 puffs of salbutam ol ev ery
3 to 4 h ours if th e attack is m ild ; 6 puffs ev ery 1 to 2 h ours if th e attack is m od erate,
until sym ptom s subsid e, th en w h en th e attack is com pletely resolv ed , proceed as
abov e.
– If sym ptom s w orsen or d o not im prov e, treat as severe attack.
Severe attack
– H ospitalise th e patient; place h im in a 1 / 2 sitting position.
– A d m inister:
• oxygen continuously, at least 5 litres/ m inute or m aintain th e2O saturation betw een
9 4 and 9 8 % .
• salbutamol (aerosol): 2 to 4 puffs ev ery 2 0 to 3 0 m inutes, up to 1 0 puffs if necessary
in ch ild ren und er 5 years, up to 2 0 puffs in ch ild ren ov er 5 years and ad ults. U se a
spacer to increase effectiv eness, irrespectiv e of ag e.
or salbutam ol (solution for nebulisation), see follow ing pag e.
• prednisolone P O : one d ose of 1 to 2 m g / kg
In th e case of v om iting , use hydrocortisone IV ev ery 6 h ours (ch ild ren:
5 m g / kg / injection,
ad ults: 1 0 0 m g / injection) until th e patient can tolerate oral pred nisolone.
– If th e attack is com pletely resolv ed , observ e th e patient for at least 4 h ours. C ontinue
th e treatm ent w ith salbutam ol for 2 4 to 4 8 h ours ( 2 to 4 puffs ev ery 4 h ours) and
pred nisolone P O (1 to 2 m g / kg once d aily) to com plete 3 d ays of treatm ent.
R eassess after 1 0 d ays: consid er long -term treatm ent if th e asth m a attacks h av e
been
occurring for sev eral m onth s. If th e patient is alread y receiv ing long -term treatm ent,
reassess th e sev erity of th e asth m a (see table, pag e 7 7 ) and rev iew com pliance and
correct use of m ed ication and ad just treatm ent if necessary.
– If sym ptom s w orsen or d o not im prov e, see life-threatening attack.
If a conventional spacer is not available, use a 500 ml plastic bottle: insert the mouthpiece of the inhaler into a hole
1
made in the bottom of the bottle (the seal should be as tight as possible). The child breathes from the mouth of the
bottle in the same way as he would with a spacer. The use of a plastic cup instead of a spacer is not recommended
(ineffective).
75
