Expert panel report 3: guidelines for the diagnosis and management of asthma--summary report 2007

FIGURE 22. DOSAGES OF DRUGS FOR ASTHMA EXACERBATIONS
Medication
Child Dose*
Adult Dose
Comments (not all inclusive)
Inhaled Short-Acting Beta2-Agonists (SABA)
Only selective beta agonists are recommended.
For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6–8 L/min. Use large volume nebulizers for continuous administration. May mix with ipratropium nebulizer solution.
4–8 puffs every 20 minutes for 3 doses, In mild-to-moderate exacerbations, MDI plus VHC is as effective as nebulized therapy with appropriate administration technique and coaching by trained Has not been studied in severe asthma exacerbations.
See albuterol dose; thought to be half as Has not been studied in severe asthma exacerbations.
Levalbuterol administered in one-half the mg dose of albuterol provides comparable efficacy and safety.
Has not been evaluated by continuous nebulization.
Has not been studied in severe asthma exacerbations half as potent as albuterol on a mg basis.
Systemic (Injected) Beta2-Agonists
No proven advantage of systemic therapy over aerosol.
No proven advantage of systemic therapy over aerosol.
Anticholinergics
May mix in same nebulizer with albuterol. Should not be used as first-line therapy; should be added to SABA therapy for severe exacerbations. The addition of ipratropium has not been shown to provide furtherbenefit once the patient is hospitalized.
Should use with VHC and face mask for children <4 years. Studies have examined ipratropium bromide MDI for up to 3 hours.
Guidelines for the Diagnosis and Management of Asthma FIGURE 22. DOSAGES OF DRUGS FOR ASTHMA EXACERBATIONS (continued)
Medication
Child Dose*
Adult Dose
Comments (not all inclusive)
Anticholinergics (continued)
May be used for up to 3 hours in the initial management of severe exacerbations. The addition of ipratropium to albuterol has not been shown to provide further benefit once the patient is hospitalized.
ipratropium bromide and 2.5 mg albuterol.) 4–8 puffs every 20 minutes as needed up Should use with VHC and face mask for children 18 mcg ipratropium bromide and 90 mcg of albuterol.) Systemic Corticosteroids (Apply to all three corticosteriods.)
For outpatient “burst,” use 40–60 mg in single or 2 divided doses for total of 5–10 days in adults (children: 1–2 mg/ kg/day maximum 60 mg/day for * Children ≤ 12 years of ageKey: ED, emergency department; MDI, metered-dose inhaler; PEF, peak expiratory flow, VHC, valved holding chamber There is no known advantage for higher doses of corticosteroids in severe asthma exacerbations, nor is there any advantage for intravenous administration over oral therapy provided gastrointestinal transit time or absorption is not impaired.
The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit of hospitalization may last from 3 to 10 days. For corticosteroid courses of less than1 week, there is no need to taper the dose. For slightly longer courses (e.g., up to 10 days), there probably is no need to taper, especially if patients are concurrently taking ICSs.
ICSs can be started at any point in the treatment of an asthma exacerbation.

Source: http://img.medscape.com/pi/editorial/pguidelines/2007/8028/art-asthsumm.fig22.pdf