Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of asthma in children and adolescents and bronchiolitis in infants and young children
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
Updated
Intravenous (IV) magnesium sulfate should be the preferred option for second-line therapy and IV short-acting beta2 agonist (SABA) the preferred option for third-line therapy in severe paediatric asthma exacerbations not responding to standard first-line therapy.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- A pragmatic stepwise approach to second-line therapies would be appropriate, and allow practitioners to choose the best possible option for their setting.
- In settings where neither preferred option is available, IV aminophylline may be considered as additional therapy in severe asthma exacerbations not responding to standard first-line therapy.
- A pragmatic stepwise approach to second-line therapies would be appropriate and allow practitioners to choose the best possible option for their setting.
- The burden of additional equipment and monitoring required for the IV administration of second-line asthma therapies, which might be a challenge and may limit its use in resource-limited settings.
- The additional cost of IV SABA is most likely to limit its use in resource-limited settings, hence the need for advocacy for its use in areas where the pre-existing infrastructure allows.
- Since IV aminophylline is more widely available, it may have a role as second-line therapy, in the absence of alternatives in the stepwise approach.