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Second line treatment for severe acute childhood asthma
  1. M South
  1. M South, Director, Department of General Medicine, Royal Children's Hospital; Associate Professor and Deputy Head, Department of Paediatrics, University of Melbourne; Research Fellow, Murdoch Children's Research Institute, Melbourne, Australia
  1. Correspondence to:
    Dr M South, Royal Children's Hospital, Parkville, Victoria 3052, Australia;

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The choice of treatment for a child with severe acute asthma unresponsive to high dose inhaled bronchodilators and oral or intravenous corticosteroids is still the subject of debate. Although both salbutamol and aminophylline have been around for a long time and have been the subject of many studies, it is still not possible unreservedly to recommend one of these agents over the other as second line treatment.

Most physicians would agree that first line treatment for an acute exacerbation of childhood asthma should be the administration of high dose inhaled bronchodilators1 and corticosteroids administered either orally or intravenously,2 but when a child with severe acute asthma is unresponsive to such treatment—what should come next? This is an important question that is faced by doctors every day in emergency departments, paediatric wards, and intensive care units the world over. Most commonly, physicians will reach next for intravenous salbutamol or intravenous aminophylline, although some will consider other treatments.

Salbutamol and aminophylline have been shown to be individually better than placebo in severe acute asthma.3,4 Although a recent Cochrane systematic review appeared to cast doubt on this statement for salbutamol,5 many suspect that this is a flaw caused by the …

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  • Conflict of interest: none.

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