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Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. 2007 October; 92(10): 937.
PMCID: PMC2083211

Different interpretations of British Thoracic Society guidelines on the emergency self‐management of asthma in children

British Thoracic Society (BTS) guidelines on the management of asthma were first published in 1990 and are regularly updated.1 The most recent update recommends that personalised asthma action plans are offered to all patients with asthma.

Such plans should describe the appropriate action to be taken when asthma symptoms worsen. Bronchodilator medication, in the form of β2 agonist, should be administered. However, it is very important that help is sought if this intervention is not effective at an accepted dose and frequency. The licensed dose of salbutamol in the acute management of asthma is 200 μg four times daily, but the doses and frequency recommended by BTS guidelines are liable to different interpretations. Studies have been undertaken using different doses of β2 agonist in the emergency situation, and one these studies showed maximum bronchodilation after four doses of 400 μg albuterol.2 Increasing inhaled steroids has not been shown to be effective in acute asthma.1

Parental feedback to specialist nurses highlighted the fact that professional staff are giving very different advice from each other, leading to confusion.

In response, two small audits were undertaken with secondary care medical staff (n = 22) and respiratory nurses attending a national meeting (n = 14). Results indicated that the range of bronchodilator dose considered acceptable for parents to administer to children aged 3 and 11 years with an acute asthma episode at home, before seeking medical advice, varied from 100 μg 2 hourly to 2000 μg 4 hourly. For the 3‐ and the 11‐year‐old children, 12 and 14 different regimes were suggested, respectively, by 36 health professionals.

Administering a high‐dose bronchodilator via a spacer is recommended as treatment for mild to moderate asthma attacks in children and is generally thought to be safe.1 We are concerned that inconsistent advice on the dose and frequency of β2 agonist may confuse parents and could result in inadequate treatment or a delay in seeking medical help. We suggest that further research and the development of a consensus on appropriate dosage and frequency of administration to be used at home would facilitate consistent and safe practice.


Competing interests: None.


1. British Thoracic Society, Scottish Intercollegiate Guidelines Network British guideline on the management of asthma. Thorax 2003. 58(Suppl 1)i1–94.94 [PMC free article] [PubMed]
2. Calacone A, Afilado M, Wolkove N. et al A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebuliser in acute asthma. Chest 1992. 104835–841.841

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