Because there are no previous studies with the same methodology found, pilot study will be conducted to estimate the sample size.~Patients who are eligible to be enrolled in the study will be randomized into two group, the experimental group which include salbutamol (standard dose), ipratropium bromide (standard dose) along with epinephrine (1ml of 1:1000) to given as nebulization.~The other group with given the standard treatment with the same doses with epinephrine. PRAM score with calculated before and at 20, 40, 90 min after the treatment.
Our study aiming to look in improvement of Pediatric Respiratory Assessment Measure (PRAM) score as a primary outcome. The secondary outcomes involving the need for second step management, need for admission and possible side effects.~It's double blinded randomized control study comparing Nebulized Epinephrine with standard treatment (salbutamol + Ipratropium) versus the standard treatment only in pediatric patient.~A pilot study will be conducted before to detect the sample size required and data will be collected at deferent interval post treatment targeting intension to treat for analysis.