Dawaa Reference

chronic

Mild-to-Moderate Acute Asthma Exacerbation in Children

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources1 source

GINA Strategy for Asthma Management and Prevention 2023

Verified against2 documents
  • GINA Strategy for Asthma Management and Prevention 2023
  • Mild-to-Moderate Acute Asthma Exacerbation in Children - disease-level clinical article (pediatric-asthma-acute-exacerbation-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • A cough that is worse at night or triggered by cold air or exercise raises suspicion for asthma [cough · night-time symptoms]
  • Daytime tiredness and falling school performance can reflect sleep disrupted by nighttime symptoms [fatigue]
  • An acute flare brings fast breathing, low oxygen, wheeze, and use of the neck and rib muscles to breathe [tachypnoea · wheeze]
  • A previously distressed child who tires out, breathes at a normal rate, and stops wheezing may actually be worsening toward respiratory failure [wheeze]

Signs — what you find (3)

  • Allergic facial signs such as Dennie-Morgan lines, a nasal crease, and dark under-eye circles often accompany asthma
  • Finding nasal polyps in a child should prompt cystic fibrosis testing rather than a routine asthma workup [nasal polyps]
  • A silent chest, blue skin color, or altered consciousness are red flags for imminent respiratory arrest

Tests (6)

  • Spirometry shows an obstructive pattern, with FEV1 under 80% predicted and an FEV1/FVC ratio below 0.85
  • A rise in FEV1 of at least 12% after a short-acting bronchodilator confirms reversible airflow obstruction
  • A 20% or greater FEV1 drop with methacholine, or 15% with hypertonic saline or mannitol, marks a positive bronchoprovocation test
  • Exhaled nitric oxide below 20 ppb in children argues against eosinophilic inflammation, while above 35 ppb supports it
  • Chest X-ray during a flare is reserved for asymmetric findings, chest pain, unexplained fever, or a child not improving with treatment
  • A sweat chloride test is considered for recurrent pneumonia, foul-smelling stool, or failure to thrive suggesting cystic fibrosis

If not this — what else fits (4)

  • Foreign body aspiration is a large-airway cause of wheeze that belongs on the differential
  • Vocal cord dysfunction is included among the large airway obstruction differentials for wheeze
  • Congestive heart failure is also considered when a child presents with wheeze-like breathing difficulty
  • Gastroesophageal reflux disease is on the list of conditions that can mimic asthma in children

SourceStatPearls "Pediatric Asthma" - disease-level clinical article

Presentation findings are traced to the source above.

1

SALBUTAMOL

1st line

Strength0.1 mg

Formoral.inhalation

Adult dose and duration

Not applicable - pediatric condition x 1-3 days during acute flare

Paediatric dose

(Children <6 years: 2-6 puffs via spacer + face mask every 20 mins for 1 hour; Children >=6 years: 4-10 puffs via spacer every 20 mins for 1 hour)

Dose by age
Under 6 years:2 to 6 puffs via spacer with face mask, every 20 minutes for 1 hour
6 years and over:4 to 10 puffs via spacer, every 20 minutes for 1 hour
Dose source

GINA Strategy for Asthma Management and Prevention 2023

Why

Inhaled short-acting beta-2 agonist (SABA) via pressurisd metered-dose inhaler (pMDI) with spacer is equal or superior to nebulizer

Cautions
  • ALWAYS USE SPACER: pMDI + spacer is as effective as nebulizer and reduces systemic side effects.
  • If child requires >6 puffs every 4 hours or shows red flags (silent chest, cyanosis, intercostal retraction, inability to talk), TRANSFER URGENTLY TO HOSPITAL.
  • Tachycardia and fine tremor are common transient beta-2 agonist side effects.
Egyptian brands
Egyptian brandManufacturerIndicative price
AEROLIN 100MCG/DOSE INHALEREIPICO > 3M HEALTH CARE-U.K.7.30 EGP
BUTALIN 100MCG/ACTUATION 200 DOSESJULPHAR12.00 EGP
VENTAL INHALER 100 MCG/DOSE 200 DOSESARAB DRUG COMPANY (ADCO)72.00 EGP
VIASALMOL 100MCG 200 ACTUATION INHALERMDI PHARMA72.00 EGP
VENTOLIN EVOHALER 100MCG/ACTUATION INHALERGLAXO SMITHKLINE86.00 EGP
OPICHESTAL SYRUP 120ML? strength differs? different route - not oral.inhalationEL-OBOUR2.00 EGP
SALBUTAMOL 2MG/5ML SYRUP 120ML? strength differs? different route - not oral.inhalationSEDICO3.50 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Mild-to-Moderate Acute Asthma Exacerbation in Children - disease-level clinical article (pediatric-asthma-acute-exacerbation-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The signs of impending respiratory failure and arrest are altered mental status, lethargy, cyanosis, and a silent chest.
3

PREDNISOLONE

add-on - not a substitute

Strength5 mg

Formoral.solid

Adult dose and duration

Not applicable - pediatric condition x 3-5 days

Paediatric dose

1-2 mg/kg/day [child max 40 mg]

(1-2 mg/kg once daily in the morning (max 20 mg for <2 yrs, 30 mg for 2-5 yrs, 40 mg for >5 yrs) for 3-5 days)

Dose by age
Under 2 years:1 to 2 mg/kg once daily in the morning, maximum 20 mg, for 3 to 5 days
2 to 5 years:1 to 2 mg/kg once daily in the morning, maximum 30 mg, for 3 to 5 days
Over 5 years:1 to 2 mg/kg once daily in the morning, maximum 40 mg, for 3 to 5 days
Dose by weight
3kg3-6 mg/day
4kg4-8 mg/day
5kg5-10 mg/day
6kg6-12 mg/day
7kg7-14 mg/day
8kg8-16 mg/day
9kg9-18 mg/day
10kg10-20 mg/day
11kg11-22 mg/day
12kg12-24 mg/day
13kg13-26 mg/day
14kg14-28 mg/day
15kg15-30 mg/day
16kg16-32 mg/day
17kg17-34 mg/day
18kg18-36 mg/day
19kg19-38 mg/day
20kg20-40 mg/day
21kg21-40 mg/day (upper capped)
22kg22-40 mg/day (upper capped)
23kg23-40 mg/day (upper capped)
24kg24-40 mg/day (upper capped)
25kg25-40 mg/day (upper capped)
26kg26-40 mg/day (upper capped)
27kg27-40 mg/day (upper capped)
28kg28-40 mg/day (upper capped)
29kg29-40 mg/day (upper capped)
30kg30-40 mg/day (upper capped)
31kg31-40 mg/day (upper capped)
32kg32-40 mg/day (upper capped)
33kg33-40 mg/day (upper capped)
34kg34-40 mg/day (upper capped)
35kg35-40 mg/day (upper capped)
36kg36-40 mg/day (upper capped)
37kg37-40 mg/day (upper capped)
38kg38-40 mg/day (upper capped)
39kg39-40 mg/day (upper capped)
40kg40 mg/day (capped)
41kg40 mg/day (capped)
42kg40 mg/day (capped)
43kg40 mg/day (capped)
44kg40 mg/day (capped)
45kg40 mg/day (capped)
46kg40 mg/day (capped)
47kg40 mg/day (capped)
48kg40 mg/day (capped)
49kg40 mg/day (capped)
50kg40 mg/day (capped)
Dose source

GINA Strategy for Asthma Management and Prevention 2023

Why

Prednisolone is an oral corticosteroid added to bronchodilator therapy during an acute asthma exacerbation to reduce airway inflammation and speed recovery; it is a short adjunct course, not maintenance therapy.

Cautions
  • Short course (3-5 days) does NOT require tapering.
  • Give with food in the morning to prevent GI distress and insomnia.
  • Re-evaluate baseline controller therapy (ICS) post-exacerbation.
Egyptian brands
Egyptian brandManufacturerIndicative price
HOSTACORTIN H 5MG 30 TAB.SANOFI12.00 EGP (0.40/unit)
PREDNISOLONE 5 MG 20 TABS.ARAB DRUG COMPANY (ADCO)24.00 EGP (1.20/unit)
PREDILONE 5MG 10 TAB. (25 STRIPS PACK)KAHIRA250.00 EGP (25.00/unit)
EPICOPRED 5 MG 30 ORODISPERSIBLE TABS.EIPICO69.00 EGP
PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS.EVA PHARMA79.50 EGP
DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS.ANDALOUS PHARMA84.00 EGP
SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS.SANOFI WINTHROP > SANOFI84.00 EGP
ACETASEE 1% EYE DROPS (SUSP.) 5 ML? strength differs? different route - not oral solidRAMEDA7.50 EGP
PREDNIS 5MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidPHAROPHARMA9.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.