#Emergency Salbutamol Application Protocol for a 30-Month-Old Child with Asthma/Bronchitis and Acute Respiratory Infection
Attention:
This information is for educational purposes only and does not replace medical evaluation and prescription. Children with severe respiratory distress, oxygen saturation drop (<92%), or previous need for nebulized adrenaline must be evaluated at an emergency service immediately. Home use of salbutamol should always follow individualized medical guidance.
#1. Situation Summary
- 30-month-old child (2.5 years) with chronic asthma/bronchitis.
- Presents with acute respiratory infection, severe cough, signs of upper airway inflammation, episodes of desaturation (<90%), and has previously required nebulized adrenaline for glottic edema.
- High-risk situation, with potential for respiratory failure.
#2. Emergency Salbutamol Use Protocol (At Home, Under Medical Guidance)
A. Indication
- Symptoms of bronchospasm: wheezing, severe cough, difficulty breathing, increased respiratory effort.
- NOT indicated for glottic edema/laryngitis (where adrenaline and corticosteroids are the treatments of choice).
B. Administration
- Preferred: Metered-dose inhaler (MDI) with spacer and face mask.
- Alternative: Nebulization, if prescribed and available.
C. Dosage and Frequency (References: GINA 2023, SBP, BTS/SIGN)
- MDI with spacer:
- Dose: 2 puffs (100 mcg/puff) for children <5 years.
- Frequency: Every 20 minutes, up to 3 times in the first hour (total of 3 doses), if needed.
- After the first hour: If improved, may space out to every 4–6 hours, as per medical advice.
- Nebulization:
- Dose: 2.5 mg salbutamol (0.5 mL of 5 mg/mL solution) diluted in 2–3 mL of saline.
- Frequency: Every 20 minutes, up to 3 times in the first hour, if needed.
- After the first hour: Space out as improvement occurs and per medical advice.
D. Monitoring
- Observe for symptom improvement: reduced respiratory effort, less coughing, improved skin/lip color.
- Monitor oxygen saturation, if possible (ideal >94%).
- Watch for side effects: tremors, tachycardia, agitation.
#3. Criteria for Immediate Emergency Care
Seek emergency care if the child presents:
- Oxygen saturation <92% (or <94% persistently).
- Severe respiratory distress: very rapid breathing, marked retractions, nasal flaring, grunting.
- Excessive sleepiness, difficulty waking, lethargy.
- Inability to speak, cry, or feed due to shortness of breath.
- Bluish lips, tongue, or nails (cyanosis).
- Stridor (harsh sound when inhaling) at rest.
- No significant response after 3 doses of salbutamol.
- Need for salbutamol every 1–2 hours after the initial phase.
#4. Limits of Salbutamol Use
- Salbutamol is a rescue medication, not for long-term control. Frequent use (>2 times per week outside of attacks) indicates the need to adjust maintenance therapy (inhaled corticosteroids).
- Emergency use for up to 30 days should only occur under medical supervision, with frequent reassessment.
- If the child needs salbutamol for more than 24–48 hours, or requires frequent doses, consult the pediatrician.
#5. Simplified Action Plan (Example)
| Situation | What to do | When to seek emergency care |
|---|---|---|
| Mild/Moderate symptoms | 2 puffs of salbutamol with spacer, repeat after 20 min if needed (max 3 times in 1st hour). | If no improvement after 3 doses. |
| Severe symptoms | 2 puffs of salbutamol, seek emergency care immediately. | If signs of severity (see above). |
| Controlled symptoms | Maintain maintenance therapy, monitor. | If symptoms return or worsen. |
#6. References
- Global Initiative for Asthma (GINA) 2023. https://ginasthma.org/
- Brazilian Society of Pediatrics (SBP) – Asthma Guidelines in Children.
- BTS/SIGN British Guideline on the Management of Asthma 2019.
- NIH/NHLBI Asthma Guidelines.
#7. Final Considerations
- Children with a history of desaturation (<90%), need for nebulized adrenaline, or signs of upper airway obstruction should be evaluated in a hospital.
- The above protocol is a general guide and does not replace in-person medical follow-up.
- Ask your pediatrician for a written asthma action plan tailored to your child.
If in doubt or if symptoms worsen, seek medical attention immediately.