Introduction: Discharge advice for the use of salbutamol after acute wheeze is highly variable across the UK. Most centres use gradually reducing fixed dose regimes. There is no good evidence to support this practice. We evaluated our local practice and assessed the safety and efficacy of introducing advice to give salbutamol only as needed after hospital discharge in all age groups.

Method: Working with 5 families of children with asthma, and health care professionals attending to wheezy children across our region, we created an information sheet to aid parents? decision making about the use of salbutamol. The leaflet included a colour coded flow chart for salbutamol use, safety netting information, instruction for inhaler technique, a table to record salbutamol use and aerosol recycling advice. Data from parents receiving the new discharge plan were collected by telephone follow up.

Results: We obtained feedback from 103 families over 4 months. Compared to our previous fixed dose 4 hourly weaning plan (Day 1: 10 puffs, day 2: 6 puffs, day 3: 2 puffs) significantly less salbutamol was used. Mean dose reductions were 73% on day 1, 72% on day 2 and 50% on day 3. 12.6% (13) were still using salbutamol after 3 days. Only 1.9% (2) reattended the emergency department and 7.7% (8) visited the GP with ongoing symptoms. All parents/carers found the chart easy to follow. 23% (24) used the table to record salbutamol use.

Conclusion: Our as required salbutamol plan was safe and acceptable. It significantly reduced the likely doses of salbutamol used according to previous fixed dose recommendations and was well accepted.