Which drug, dose, and delivery route is correct for an 18-kg child experiencing severe respiratory distress due to bronchospasm?

• A. Albuterol, 2.5 mg nebulized
• B. Epinephrine, 0.01 mg/kg IM
• C. Ipratropium, 0.5 mg nebulized
• D. Prednisone, 40 mg oral

Answer: (C)

In severe bronchospasm, the goal is fast, effective bronchodilation using inhaled medications. A short-acting beta-agonist like albuterol provides quick relief, but adding an anticholinergic bronchodilator enhances and prolongs the effect by blocking acetylcholine-mediated airway constriction. Ipratropium bromide given by nebulization at 0.5 mg delivers this additive bronchodilation directly to the lower airways, which is particularly helpful in significant distress and in pediatric patients around this weight, producing rapid improvement. Nebulized delivery is favored here because it allows the medicine to act quickly where it’s needed.

Oral prednisone acts more slowly and won’t relieve the acute bronchospasm promptly, and epinephrine IM is reserved for life-threatening situations or when inhaled therapy fails, not as a first-line stand-alone in this scenario. Hence, ipratropium 0.5 mg nebulized is the best choice for an 18-kg child with severe bronchospasm.