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Management of the Sick Child
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
After the first hour of emergency treatment, children should be reassessed after each intervention.If the patient continues to improve and now has only mild symptoms, they can be discharged home, as long as the caregiver can recognise danger signs and bring the patient back to healthcare facilities should their condition deteriorate. They should complete a 3–5-day course of prednisolone and taper inhaled salbutamol over the next 2–3 days until symptoms cease.2,6If still severe or very severe asthma, inpatient management is required – arrange safe transfer for inpatient management while continuing oxygen and inhaled or nebulised medications.
Pediatric Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Michael Teik Chung Lim, Mahesh babu Ramamurthy, Daniel Yam-Thiam Goh
Management in clinic/emergency department: When a child presents to the emergency department or the doctor’s clinic with an asthma exacerbation, the severity of the child’s condition is established. The vital parameters including oxygen saturation are measured and monitored. If oxygen saturation is less than 92% in room air, supplemental oxygen is started. Upto 6 puffs of salbutamol 100 mcg inhaler are given every 20 minutes. However, if the child is hypoxic and requires oxygen, then salbutamol can be nebulized. In children less than 6 years of age, the dose is 2.5 mg salbutamol (0.5 ml of 0.5% salbutamol) mixed in with 2.5 ml of 0.9% sodium chloride solution. In older children, 5 mg salbutamol (1 ml of 0.5% salbutamol) mixed in with 2 ml of 0.9% sodium chloride solution is used. This can be repeated up to 3 times every 20 minutes. If the symptoms and wheeze persist, then a second round of salbutamol in combination with ipratropium bromide (250 to 500 mcg) is nebulized every 20 minutes up to 3 times. A dose of oral prednisolone (1–2 mg/kg body weight) is given as well. If the child improves, the child is monitored in the clinic and sent home with a 3-day course of oral prednisolone and salbutamol 100 mcg inhaler with an MDI with spacer (2–4 puffs to be taken every 4 hours as required). A follow-up appointment should be made to see the child in the clinic in 3 days’ time.
Targeting the Nervous System
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
Salbutamol has the same potency as isoprenaline, but is 2000 times less active on the heart, and with a duration of action of 4 hrs; not being recognised by certain metabolic enzymes. Salbutamol became a market leader for treating asthma in 26 countries. It was marketed as a racemate, but the R-enantiomer is 68 times more active than the S-enantiomer, which also accumulates in the body to give side-effects. As a result, the R-enantiomer (levalbuterol) was marketed.
Sustained delivery of salbutamol from cubosomal gel for management of paediatric asthma: in vitro and in vivo evaluation
Published in Journal of Microencapsulation, 2022
Huifang Zhang, Yanjie Cui, Xiaochun Zhang, Xunling Yuan, Dandan Xu, Lei Zhang
Salbutamol is a drug of choice in the treatment and management of chronic and nocturnal asthma (Sears and Lötvall 2005, Lalloo et al.2007). However, after oral administration it undergoes extensive first pass metabolism and showed poor oral bioavailability of 14.8% (Pond and Tozer 1984, Kurosawa et al.1993). The short biological half-life (4–6 h) and low peak plasma concentration (1.2–1.5 µg/mL) after oral and inhalation route required frequent dosing (Morgan et al.1986, Andrzejowski and Carroll 2016). Therefore, there is a need to improve the systemic bioavailability of salbutamol through sustained drug delivery via non-invasive skin route for effective management of asthma. To improve the bioavailability and to achieve the sustained drug delivery, lipid-based vesicular systems have gained much attention in recent years, as they can entrap both lipophilic and hydrophilic drugs (de Araújo et al.2019). Biocompatible and biodegradable lipid-based drug delivery carriers include liposomes, solid lipid nanoparticles, nanostructured lipid nanoparticles, ethosomes, phytosomes, cubosomes, etc., and have peculiar advantages and limitations (Chime and Onyishi 2013, Ijaz et al.2018). Recently, cubosome application has increased owing to their biocompatibility, specific shape, and stability (Barriga et al.2019, Gaballa et al.2020).
Intravenous magnesium sulphate in children with acute wheeze: a nationwide survey
Published in Journal of Asthma, 2021
Marlon van Weelden, Bart E. van Ewijk, Frans B. Plötz
Of our respondents, twenty-three percent and seventeen percent experienced adverse effects of iv MgSO4 in AEVW and AA, respectively. In the Turkish survey, twenty-nine percent of the respondents reported adverse effects (8). Hypotension was the most described adverse effect in both our study and the other surveys (8,15). Of our respondents, nineteen percent and fourteen percent experienced hypotension in AEVW and AA, respectively. This is comparable with thirteen percent in AA in the Turkish survey and twenty-four percent in AA (8) in the American-Canadian survey (15). Finally, in our survey a second dose of iv MgSO4 was reported to be given quite often (by 66% of the respondents) in both AEVW and AA; in case of clinical worsening after good initial response or not optimal response of first dose, and to avoid intravenous salbutamol or intensive care admission. This advice is not given by national guideline or mentioned as option in several guidelines, and might delay the step to intravenous salbutamol.
Knowledge, practice pattern and attitude toward asthma management amongst physicians from Nepal, Malaysia, Lebanon, Myanmar and Morocco
Published in Journal of Asthma, 2021
Ramesh Chokhani, Abdul Razak, Mirna Waked, Win Naing, Abdelaziz Bakhatar, Urvi Khorani, Vaibhav Gaur, Jaideep Gogtay
Our study has shown that salbutamol is a widely prescribed reliever medication in all the countries. While, Ipratropium is not in the list of recommended medications for asthma as a reliever it was still used by an average of 5.1% physicians in all countries and 10% of which is contributed by Lebanon. Formoterol/budesonide combination is also recommended to be used as a SMART therapy. In trials such as the COMPASS (25), STAY (26) and COSMOS (27) trials, it is reported that SMART therapy with formoterol/budesonide combination significantly reduces severe exacerbations in adults and adolescents and increases time to next exacerbation. Having said this the results from the present study show, not more than 16% physicians prefer it. However, in Lebanon, it was observed that almost 32% physicians prescribed the SMART therapy as a reliever and maintenance medicine both; whereas in Morocco, this response was very unpopular with only 2% physicians.