- MDI and spacer
- Less than 5-years-old: 4 puffs every 20 minutes PRN times 3
- Greater or equal to 5-years-old: 8 puffs every 20 minutes PRN times 3
- Nebulized single intermittent
- 2.5 mg (0.5 mL of 0.5% inhalation solution) every 20 minutes prn times 3 doses, with or without ipratropium
- Nebulized continuous x 1 hour
- Less than 5-year-old: 10 mg/hour
- Greater or equal to 5-year-old: 15 mg/hour
Based on low to very low evidence published since the parent guideline (GINA, 2018) the Asthma ED CPG team makes a strong recommendation to use an MDI with spacer (add a mask in children < 4 years old) preferentially for mild to moderate asthma exacerbations in the ED/UCC. There was no difference in the number of patients admitted to the hospital when either method was used, which means that either therapy is appropriate. Using an MDI did not cause adverse effects.
For additional information click here for the Specific Care Question: MDI vs. NEB for a Mild to Moderate Asthma Exacerbation
GINA. (2018). Global Strategy of Asthma Management and Prevention.