# Mild-to-Moderate Acute Asthma Exacerbation in Children - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: GINA Strategy for Asthma Management and Prevention 2023 - Verified date: 2026-08 ## Verified against - GINA Strategy for Asthma Management and Prevention 2023 - Mild-to-Moderate Acute Asthma Exacerbation in Children - disease-level clinical article (pediatric-asthma-acute-exacerbation-full.txt) ## Treatment metadata - Salbutamol — 0.1 mg — oral.inhalation - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text MILD-TO-MODERATE ACUTE ASTHMA EXACERBATION IN CHILDREN Sources: GINA Strategy for Asthma Management and Prevention 2023 Review status: REVIEWED against GINA Strategy for Asthma Management and Prevention 2023, Mild-to- Moderate Acute Asthma Exacerbation in Children - disease-level clinical article (pediatric-asthma-acute-exacerbation-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - A cough that is worse at night or triggered by cold air or exercise raises suspicion for asthma [cough · night-time symptoms] - Daytime tiredness and falling school performance can reflect sleep disrupted by nighttime symptoms [fatigue] - An acute flare brings fast breathing, low oxygen, wheeze, and use of the neck and rib muscles to breathe [tachypnoea · wheeze] - A previously distressed child who tires out, breathes at a normal rate, and stops wheezing may actually be worsening toward respiratory failure [wheeze] SIGNS - what you find (3) - Allergic facial signs such as Dennie-Morgan lines, a nasal crease, and dark under-eye circles often accompany asthma - Finding nasal polyps in a child should prompt cystic fibrosis testing rather than a routine asthma workup [nasal polyps] - A silent chest, blue skin color, or altered consciousness are red flags for imminent respiratory arrest TESTS (6) - Spirometry shows an obstructive pattern, with FEV1 under 80% predicted and an FEV1/FVC ratio below 0.85 - A rise in FEV1 of at least 12% after a short-acting bronchodilator confirms reversible airflow obstruction - A 20% or greater FEV1 drop with methacholine, or 15% with hypertonic saline or mannitol, marks a positive bronchoprovocation test - Exhaled nitric oxide below 20 ppb in children argues against eosinophilic inflammation, while above 35 ppb supports it - Chest X-ray during a flare is reserved for asymmetric findings, chest pain, unexplained fever, or a child not improving with treatment - A sweat chloride test is considered for recurrent pneumonia, foul-smelling stool, or failure to thrive suggesting cystic fibrosis IF NOT THIS - what else fits (4) - Foreign body aspiration is a large-airway cause of wheeze that belongs on the differential - Vocal cord dysfunction is included among the large airway obstruction differentials for wheeze - Congestive heart failure is also considered when a child presents with wheeze-like breathing difficulty - Gastroesophageal reflux disease is on the list of conditions that can mimic asthma in children Source StatPearls "Pediatric Asthma" - disease-level clinical article Status traced to the source above 1. SALBUTAMOL [1st line] Adult Not applicable - pediatric condition x 1-3 days during acute flare Peds Under 6 years: 2 to 6 puffs via spacer with face mask, every 20 minutes for 1 hour 6 years and over: 4 to 10 puffs via spacer, every 20 minutes for 1 hour (Children <6 years: 2-6 puffs via spacer + face mask every 20 mins for 1 hour; Children >=6 years: 4-10 puffs via spacer every 20 mins for 1 hour) Source GINA Strategy for Asthma Management and Prevention 2023 Why Inhaled short-acting beta-2 agonist (SABA) via pressurisd metered-dose inhaler (pMDI) with spacer is equal or superior to nebulizer Caution ALWAYS USE SPACER: pMDI + spacer is as effective as nebulizer and reduces systemic side effects. If child requires >6 puffs every 4 hours or shows red flags (silent chest, cyanosis, intercostal retraction, inability to talk), TRANSFER URGENTLY TO HOSPITAL. Tachycardia and fine tremor are common transient beta-2 agonist side effects. Egypt AEROLIN 100MCG/DOSE INHALER EIPICO > 3M H... 7.30 EGP BUTALIN 100MCG/ACTUATION 200 DOSES JULPHAR 12.00 EGP VENTAL INHALER 100 MCG/DOSE 200 DOSES ARAB DRUG COMPANY (ADCO) 72.00 EGP VIASALMOL 100MCG 200 ACTUATION INHALER MDI PHARMA 72.00 EGP VENTOLIN EVOHALER 100MCG/ACTUATION INHALER GLAXO SMITHKLINE 86.00 EGP OPICHESTAL SYRUP 120ML EL-OBOUR 2.00 EGP -> ? strength differs, ? different route - not oral.inhalation SALBUTAMOL 2MG/5ML SYRUP 120ML SEDICO 3.50 EGP -> ? strength differs, ? different route - not oral.inhalation 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Mild-to-Moderate Acute Asthma Exacerbation in Children - disease-level clinical article (pediatric-asthma-acute-exacerbation-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The signs of impending respiratory failure and arrest are altered mental status, lethargy, cyanosis, and a silent chest. 3. PREDNISOLONE [add-on - not a substitute] Adult Not applicable - pediatric condition x 3-5 days Peds 1-2 mg/kg/day [child max 40 mg] (1-2 mg/kg once daily in the morning (max 20 mg for <2 yrs, 30 mg for 2-5 yrs, 40 mg for >5 yrs) for 3-5 days) Under 2 years: 1 to 2 mg/kg once daily in the morning, maximum 20 mg, for 3 to 5 days 2 to 5 years: 1 to 2 mg/kg once daily in the morning, maximum 30 mg, for 3 to 5 days Over 5 years: 1 to 2 mg/kg once daily in the morning, maximum 40 mg, for 3 to 5 days 3kg -> 3-6 mg/day 4kg -> 4-8 mg/day 5kg -> 5-10 mg/day 6kg -> 6-12 mg/day 7kg -> 7-14 mg/day 8kg -> 8-16 mg/day 9kg -> 9-18 mg/day 10kg -> 10-20 mg/day 11kg -> 11-22 mg/day 12kg -> 12-24 mg/day 13kg -> 13-26 mg/day 14kg -> 14-28 mg/day 15kg -> 15-30 mg/day 16kg -> 16-32 mg/day 17kg -> 17-34 mg/day 18kg -> 18-36 mg/day 19kg -> 19-38 mg/day 20kg -> 20-40 mg/day 21kg -> 21-40 mg/day (upper capped) 22kg -> 22-40 mg/day (upper capped) 23kg -> 23-40 mg/day (upper capped) 24kg -> 24-40 mg/day (upper capped) 25kg -> 25-40 mg/day (upper capped) 26kg -> 26-40 mg/day (upper capped) 27kg -> 27-40 mg/day (upper capped) 28kg -> 28-40 mg/day (upper capped) 29kg -> 29-40 mg/day (upper capped) 30kg -> 30-40 mg/day (upper capped) 31kg -> 31-40 mg/day (upper capped) 32kg -> 32-40 mg/day (upper capped) 33kg -> 33-40 mg/day (upper capped) 34kg -> 34-40 mg/day (upper capped) 35kg -> 35-40 mg/day (upper capped) 36kg -> 36-40 mg/day (upper capped) 37kg -> 37-40 mg/day (upper capped) 38kg -> 38-40 mg/day (upper capped) 39kg -> 39-40 mg/day (upper capped) 40kg -> 40 mg/day (capped) 41kg -> 40 mg/day (capped) 42kg -> 40 mg/day (capped) 43kg -> 40 mg/day (capped) 44kg -> 40 mg/day (capped) 45kg -> 40 mg/day (capped) 46kg -> 40 mg/day (capped) 47kg -> 40 mg/day (capped) 48kg -> 40 mg/day (capped) 49kg -> 40 mg/day (capped) 50kg -> 40 mg/day (capped) Source GINA Strategy for Asthma Management and Prevention 2023 Why Prednisolone is an oral corticosteroid added to bronchodilator therapy during an acute asthma exacerbation to reduce airway inflammation and speed recovery; it is a short adjunct course, not maintenance therapy. Caution Short course (3-5 days) does NOT require tapering. Give with food in the morning to prevent GI distress and insomnia. Re-evaluate baseline controller therapy (ICS) post-exacerbation. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)