Acute onset, wheezing and cough

Treatment

• Albuterol-ipratropium nebulizer

• Methylprednisolone 125mg IV

Disposition

• After 3rd nebulizer PF = 300

• Albuterol inhaler with spacer

• Prednisone 60 mg/50/40/30/20/10 then stop q day

• F/U PCP in 2-3 days for recheck

Authors:

• Matthew Hansen, MD Oregon Health & Science University

• David Sheridan, MD Oregon Health and Science University

Editors:

• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

• Douglas Baker, MD Johns Hopkins University School of Medicine

• Mohamud Daya, MD Oregon Health & Science University

• Bronchospasm

Differential Diagnosis

• Pneumonia

• Bronchospasm

• Status asthmaticus

• Bronchitis

Patient Workup

• History • Physical exam

• Chest X-ray

• Peak flow meter

Editor’s Notes

Traditionally, peak flow should be measured with the patient standing up. Peak flow measurement is compared to height-linked norms. Patients with chronic asthma should develop normative values at home. Baseline peak flows when the child is well can be helpful with acute exacerbations as another measure of disease severity.