For a child presenting with an acute wheezy episode, a good starting point is “salbutamol burst” therapy. Give 10 puffs from a salbutamol MDI (metered dose inhaler) into a spacer device and mask. Have the child breathe steadily from the spacer over a 10 minute period and then assess the response by repeating your observations. Salbutamol burst therapy appears to be as effective as a nebuliser in mild to moderate wheeze and may have other advantages such as less tachycardia.
Here are three potential outcomes for a wheezy child who has been trialled with a 10 puff salbutamol burst:
A good response
A poor response but O2 saturations above 92%
A poor response and O2 saturations below 92%
For each of the above response scenarios, in the upcoming quiz section you will have a chance to select the further management options you consider appropriate.