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  • 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

Key results:

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.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.