For an 18-kg child with bronchospasm, which drug and delivery method is recommended?

• A. Albuterol, 2.5 mg nebulized
• B. Ipratropium, 0.5 mg nebulized
• C. Epinephrine, IM 0.01 mg/kg
• D. Prednisone, oral

Answer: (B)

In pediatric acute bronchospasm, the goal is rapid bronchodilation with a delivery method that works well for young children. Ipratropium bromide is an anticholinergic that relaxes airway smooth muscle by blocking muscarinic receptors, which reduces bronchoconstriction driven by the vagal nervous system. Delivering it by nebulization allows the medicine to reach the lower airways effectively, which is especially helpful in an 18-kg child who may have difficulty cooperating with inhalers. A common pediatric nebulized dose is 0.5 mg, and this can be given in repeated doses if needed to deepen bronchodilation. While inhaled beta-agonists like albuterol provide strong, rapid relief, ipratropium adds a different mechanism of action and is often used in acute pediatric bronchospasm to augment bronchodilation. Prednisone isn’t for immediate relief, and intramuscular epinephrine is reserved for more severe, life-threatening scenarios or anaphylaxis, making the nebulized anticholinergic a practical, effective choice in this setting.