I discourage my colleagues from the use of oral bronchodilators, because of pharma safety. In particular in incompliant patients/parents, children may get into dangerous situations, if the bronchodilators are overdosed!

Do u use oral steroids in cases of bronchioconstriction in young children. If we use steroids parents start using steroids irrespective of indication in all respiratory problems. Specially when the drugs are freely sold at the pharmacy counter

If medically determined that a bronchodilator is needed than an oral/liquid formulation can be safely used in children that are very young. For those children that are older and can coordinate their breathing, such as children 18-24 months, using an aerosol pMDI plus a large volume spacer should be an option. You may also want to consider using crushed beta agonist tablets,

I agree with the disrecommedation for oral bronchodilatators.

for inhaled inake in ressource limited conditions, you can make a inhalation chamber with two (top) half bottles of water. The two top halfs with same model of bottle follow suit. The bottleneck fits exactly with the spray and on the other side in the olders you can use their mouth. For the youngest, you can make a device protecting the edge in contact with another half bottle, cotton and sticking.

However use recommended high dosage : 1 spray (100 micg)/2 kg of weight. up to 10 (or 15 sometimes) and repeat every 10 minutes in severe cases.

according to guidelines [http://erj.ersjournals.com/content/32/4/1096.full] we should avoid other routes of administration of short-acting beta-agonists! Serious adverse events can occur [tremor, agitation, seizures, extreme tachycardia]. And dose-errors are more frequent in this setting!

Inhaled bronchodilators should be used in the correct dose for severity and purpose [low-dose for exercise-induced bronchospasm and high dose for the accute setting - see the comment of Remi Laporte!]

Firstly oral bronchodilators are beta agonists not beta antagonists

There is no evidence of efficacy at any age and should not be used

The side effects of oral Albuterol( salbutamol) is 20 times more than MDI spray and it is significantly less effective. So, just forget oral syrup and use spray in your practice!

Side effects of oral beta adrenergic agonists make them contraindicated. Their use should be discourage based on all standard guidelines

Oral bronchodilator should be discouraged, inhalation is the prefared method of delivering bronchodilators

In Taiwan, national health insurance didn't cover long term use bronchodilator inhalation. Sometimes, we prescribed oral beta adrenergic agonist instead of inhalation one. As young as 3 months old baby could tolerate it. But you should start it from lowest dose and the response was variable.

nebulization therapy is too expensive for most of our poor population and also its use may be very difficult for the illiterate. We do use oral bronchodilators in children and there is no specific age limit in most of the cases however in children less than 1 year it is usually avoided.

I totally agree that inhalation is the preferred choice and oral use should be discouraged

All depend in what class of country you are practice and what medicine do you have, in my long experience you can use from 3 month of age nebulizacion therapy, or aerosol pMDI with and spacer, if you don´t have and spacer you could use a plastic glass wih a hole in the base ,if you have sirup and the children if not vomitin you can use this.References: PIR of AAP , GINA protocols, Guideline for Asthma NHLBIH of USA

ICU of Levin,Respiratory Therapy by Stein.Remenber in every breath the baby catch and only introduce in the lung the that he or she need.

And if you have aminophiline you can use this if you Know good the Pharmacology and pharmacocinetic, before of the Chang studies who compare aminophiline with albuterol and cortoicosteroids and He observed that not exist any difference only the potencial risk of colateral effects of aminophiline. We used accord WHO protocols aminofiline and never seen complications 28 years ago. Then I changed at the actual GINA protocols but in young MD who don´t have aerosols or nebulizers pass the time and the patient will be more bad or critical ill and lost the oportunity of use aminiphiline with excelent results ( NEJM ).

The plastic glass used as spacer has been found to be very effective not only in very young children but also in some older children in whom spacer device was not proving very effective. One reason for the spacer failure was that the child would breathe through his nose while holding the spacer in his mouth. Although I have been using theophylines orally and have found them reasonably safe but on the other hand I have not found them very effective in controlling bronchospasm however I/V aminophyline is another story.

That ´s right , in our poor hispanic population was efective, but if the patient is alergic to corticosteroids and antileucotrien ,at intercrisis there is not another choice

In crisis IV aminophyline is a very good choice and you are very lucky if in your population oral theophyline was effective. Allergy to steroids is something interesting, Never experienced it or heard about it. Judicious use of steroids in asthma is corner stone of management of childhood asthma these days

Your question is not complete as you don't mention your patient's age and what the problem is. some colleagues prescribe bronchodilators in bronchiolitis in children whose pathology has not bronchoconstriction component as seen in asthma ! So no evindence-based proof for bronchodilators in this condition. As for asthma, why not use simply use nebulized salbutamol ? In children under 6 - 8 months with two or three episodes of bronchiolitis you will hardly find real responders. Theophylline as advised by some colleagues is not used in France because of side effects (GI), Salbutamol where indicated is effective, my Department manages over two hundreds asthmatics, we have good experience...

We are specifically talking about asthma. In our set up nebulized salbutamol is the first line therapy for acute attacks and for use as reliever medication but is not very good for long term control. Also it has very short duration of action. LABAs long acting B agonists in combination with mild steroids like fluticasone are very effective if used properly. An important is that in my opinion the most important factor is pateint education and compliance by the patient.

Oral bronchodilators are contraindicated in children less than 2 years of age, but according to most guidelines inhalator bronchodilators are now recommended by the age of 3 month on. If in your country the MDI Salbutamol is available, and affordable, but a proper spacer is to expensive for some parents, my advice is to use the plastic Coca -Cola bottle, the spray head fits perfect to the bottle...

Of course you should put some cotton wool on the opposite side of the bottle which could be rough because you should cut it to permit the child to inhale inside the bottle.

In response to Ioana's comment, I wanted to add a reply to the use of plastic bottles as a quick and easy spacer. I have used this approach while in the field in Haiti and Belize, and have found this approach works to a certain degree. Just make sure that you use the correct sized bottle, 500 ml, 1L or 2L. I have found that in most situations, a 1L bottle works fine. Offers the correctly sized opening and you can cut off about 1/3 of the bottle going about 250-300 mls of space. Based on my experience, I would also recommend the use of a 250 ml styrofoam coffee cup. It is easier to use and the interior volume of the cup more closely matches the volume of an Aerochamber like spacer. Also, you do not have the problems of dealing with the sharp edges of a plastic bottle. Interior volume, placement and comfort are important considerations. You can easily poke a small hole in the bottom of the cup. Make this hole the correct size and shape as the mouth piece of the pMDIs will vary. This hole is fairly tight as styrofoam bends around the shape of the mouthpiece. When placed against the face of the child, it fits fairly tight. The child opens their mouth as the operator then presses the pMDI and the aerosol discharges nicely. The child breaths normally for 10 seconds. Repeat as needed. The only problem I have experienced is electrostatic charge, but this can be reduced by wiping out the cup before use. In situations where pMDIs or nebulizers can't be used, I would also again suggest the use of crushed tablets or liquid syrup for use in the younger children. SImple to carry and simple to use with much better efficacy. While not always "approved" for use in countries, the use of these oral medications offer the efficacy that is needed in these acute situations.

Styrofoam cup is very convenient and effective.

Great answers above . I always take a good family history and this gives me some indication if there really is atopy in the Family. I check about smoking in the house or in relatives houses and council on this . If the infant is young and not responding I may try at a later date and I tell their parents that the air way may not be mature enough...

What do we tell the parents about the chances of the children growing out of asthma. What is the age at which a child is finally labelled as asthmatic

Most of the transient phenomena of early childhood associated with wheezing are gone by school age. According to Martinez phenotypes of wheezing during childhood early-transient wheezing is remmitent by age of 3-4 years and wheezing-associated respiratory infections start to decrease in frequency by the age of 7-8 years. Real asthma [IgE-associated wheezing from Martinez phenotypes model] is not decreasing in frequency even during puberty. So in a school age child we can perform spirometry and IgE testing, eventually skin prick tests for aero-allergens and we c

Please read also "Asthma and Wheezing in the First Six Years of Life" in New England Journal of Medicine.

http://www.nejm.org/doi/full/10.1056/NEJM199501193320301

In my opinion real asthma patients should have several of the following risk-factors : family history of asthma or severe allergies, wheezing apart colds [with exercise, in cold weather, in a polluted environement, during high-pollen season, etc] and need for controller medication [inhaled steroids or leukotriene-receptor antagonists] in order to achieve a decent quality of life.

If none of these factors are present we should be reluctant to label a wheezy infant as asthma. Parents have different perceptions about the term "asthma" [I have witnessed serious asthma-phobia "attacks" in some parents that were not gently approached!]

Betwen 1950 and 1984 Asthma was consider the Patient whose had three attacks of wheezing and broncho spasm , independent of etiology.

The incidence of asthma is increasing rapidly world wide. It is a multi factorial problem and it is really difficult to exactly point out the causes of this increase. I just wanted to know if the increasing vaccination coverage of common ailment can some how contribute to increase in the incidence of asthma?

Eva, there are many studies available which confirm the rising trend of asthma globally. I am citing below 2 references one from US (developed) and other from Pakistan (developing) country:

According to the most recent US Centers for Disease Control and Prevention (CDC) Asthma Surveillance Survey, the prevalence of current asthma during 2001-2003 prevalence is estimated at 6.7% in adults and 8.5% in children, and the burden of asthma increased more than 75% from 1980-1999.[1,2]

1. Asthma prevalence and control characteristics by race/ethnicity--United States, 2002. MMWR Morb Mortal Wkly Rep. Feb 27 2004;53(7):145-8. [Medline].

2. Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma--United States, 1980-2004. MMWR Surveill Summ. Oct 19 2007;56(8):1-54. [Medline].

J Asthma. 2009 Feb;46(1):86-90. doi: 10.1080/02770900802513023.

Prevalence of asthma and allergic rhinitis among school children of Karachi, Pakistan, 2007.

Hasnain SM, Khan M, Saleem A, Waqar MA.

As the incidence in increasing all over the world so we have to look for some other reasons also in addition to a particular life style. In my opinion the rapidly environmental pollution is a much bigger risk factor

Unfortunately parents in our  society don't accept the inhalers and nebulizer according to them child will be dependant. And the parents insist on oral drugs What in  situation in other under developed countries ???

A few years ago (2003 and 2004) the use of inhalers was not accepted according to them child will be dependant; with the opening of a new Pediatric Specialty Hospital, the use of inhalers and / or nebulizers plus parents education, this has been accepted (13 to 14 years after).

Hace algunos años (2003 y 2004) no se aceptaba el uso de inhaladores, con la idea de que el niño se haga dependiente, con la apertura de un Nuevo Hospital Pediátrico de Especialidades, el uso de inhaladores y/o Nebulizaciones más educación de los padres, este ha sido aceptado (13 a 14 años después)