Treatment For Wheezing and Asthma In Children

Medications used in a Nebulizer (Nebulizer treatments are best when your child is sick)

• Albuterol (Ventolin / Proventil) Nebulizer Solution 0.5%: 0.25 cc or 0.5 cc (use dropper in bottle)
• Intal nebulizer solution (2 cc/vial) or Saline nebulizer solution (pump dispenser): use 2 cc (Mix above solutions in nebulizer chamber. Use with each nebulizer treatment.)
• Premix of albuterol and saline (0.083% inhalation solution for nebulizer): 1 vial=3 cc.
• Pulmicort: _____________________________

Medications (taken by mouth) / Inhalers

• Albuterol syrup (2 mg/teaspoon) / Tablets (4 mg): Dose: ____teaspoon or ½ -1 tablet every 4-6 hours.
• Metered dose inhalers (MDI) with albuterol: Dose: 2 puffs every 4-6 hours.
• Inhaled steroid MDI’s (Flovent, Vanceril, Beclovent, Pulmicort): Dose: 1-2 puffs 1-2 times a day.
• Oral prednisone: Dose: ____teaspoon (s) or _____mg: Given once a day for ____ days.

MDI’s must be used with a spacer (Aerochamber / Optihaler / Inspirease) to increase delivery of the medicine into your child's lungs. Maxair autohaler does not need a spacer device.

Albuterol syrup or MDI can be used as a substitute at school or other times when nebulizer is not accessible. Keep a record of how often your child is using his/her MDI. Improper usage or over-usage may indicate your child's wheezing is not adequately controlled.

Do not use albuterol syrup or MDI sooner than 2 hours after a nebulizer treatment.

To check if MDI is empty: Place MDI in a bowl of water- A full MDI will sink. if more than ½ of MDI is floating above the water, then the MDI should be replaced. Shaking the MDI will not help in determining if it is empty-there is propellant always present.

How And Why To Use A Home Peak Flow Meter

A Peak Flow Meter must be used at home to help determine the following:

• When your child requires a nebulizer treatment and how frequent treatments are needed.
• Alert you to call our office because peak flow readings are abnormal.
• When to stop treatments because your child is symptom-free and peak flows are normal.

How Do I Determine My Child's Personal Best Peak Flow Value?

When your child is well, record your child's highest value. This will be used as the personal best value. This value is used to calculate the green, yellow, and red zones as follows:

Peak Flow Meter Zones:

• Green Zone (80-100% of the personal best): Over ______ This is the Safe Zone. Your child's readings should be in this range when his/her wheezing is under control. Give treatments every 4-6 hours.
• Yellow Zone (50-80% of the personal best): _____-_____ This is the Caution Zone. If your child's readings are in this range, give treatments every 1-2 hours until peak flow readings stay in the green zone. You can give up to 6 treatments 1-2 hours apart, as long as your child moves into the green zone. Call our office if your child does not move into the green zone or shows no improvement after 4 treatments given 1 hour apart.
• Red Zone (less than 50 % of the personal best): Less than _____ This is the Danger Zone. Give 3 treatments, 20 minutes apart over one hour and call our office. If your child’s peak flows do not move into the yellow zone after 1 hour, take your child to the emergency room immediately.

Peak flow readings should be done in the following situations:

• Once a day when your child is well to determine his/her personal best.
• Anytime your child is coughing and/or wheezing to help decide if treatments are necessary.
• Before and after each nebulizer treatment to help determine if the treatment is helping your child.

Coughing is normal after a treatment and is a sign that the treatment is working.

If coughing occurs excessively during a treatment, the treatment may be stopped until the cough resolves. Treatment should be continued until all the medicine is finished.

A rapid heart rate and shaking during and after a treatment may occur with the use of albuterol. If it continues more than a few minutes, please stop the treatments and call our office.