What is the general approach when a pediatric patient with asthma exacerbation does not improve after initial bronchodilators?

• A. Administer additional bronchodilators per protocol, monitor for deterioration, and transport
• B. Stop bronchodilators
• C. Start antibiotics
• D. Transport only

Answer: (A)

When a pediatric patient with an asthma flare does not improve after the first bronchodilators, the priority is to push the bronchodilator treatment forward rather than pause or switch strategies. Additional bronchodilators should be given per your protocol—either repeating doses or moving to a continuous nebulization as permitted—to keep relaxing the airway smooth muscle and relieve bronchospasm. At the same time, maintain airway support and oxygenation, using supplemental oxygen to keep oxygen saturation in the target range. Monitor closely for signs that the condition is worsening—new or increasing work of breathing, fatigue, abnormal mental status, cyanosis, or falling oxygen levels—and be prepared to escalate care or transition to a higher level of care. Antibiotics aren’t indicated unless there’s a concurrent bacterial infection, and simply transporting without continuing treatment would miss the ongoing need to reverse bronchospasm.