Which is the most appropriate treatment for a 6-year-old child with asthma presenting with wheeze and a peak expiratory flow rate of 60% of the best predicted value?

• A. Ipratropium bromide inhaler
• B. Salbutamol via a spacer
• C. Salbutamol inhaler without spacer
• D. Oral beta-agonist syrup

Answer: (B)

When a child with asthma has acute wheeze and a reduced peak expiratory flow (60% of best predicted), the priority is rapid relief of bronchoconstriction with a fast-acting inhaled bronchodilator. Salbutamol is a short-acting beta-2 agonist that works quickly to dilate the airways. Delivering it via a spacer ensures more of the drug reaches the lungs, which is especially important in children who may have trouble coordinating inhalation with inhaler actuation. This route provides quicker, more reliable relief with fewer local side effects.

Using an inhaler without a spacer can be less effective in a 6-year-old due to coordination challenges, making the response slower or incomplete. An ipratropium bromide inhaler is not the first choice for acute relief in this scenario, though it can be considered as an add-on in more severe cases. An oral beta-agonist syrup would have slower onset and less predictable delivery to the lungs, making it unsuitable for immediate relief.