OBJECTIVE: To reanalyze data from two previous studies to provide stronger evidence of benefit for early use of single-dose intravenous bolus salbutamol in children with acute severe exacerbations of asthma. Methods: Randomized, double-blind, placebo-controlled trial of 84 children with acute severe asthma who presented to the emergency department of the Children's Hospital at Westmead. After clinical evaluation, patients who had severe asthma were given high-dose inhaled salbutamol and had an intravenous cannula inserted. Additional treatment consisted of intravenous methylprednisolone (1 mg/kg), oxygen (6 L/min via mask if Sao(2) was <93%). Patients were then randomized to receive an intravenous infusion of either 15 &mgr;g/kg salbutamol or saline, with clinical progress assessed hourly for 2 hrs. All patients were admitted to the hospital and clinically monitored for the proceeding 2-24 hrs, with inhaled salbutamol treatment administered in accord with the hospital's protocol. RESULTS: The intravenous salbutamol group (n = 50) demonstrated earlier clinical improvement, with earlier reduction in oxygen therapy and reduced need for ongoing inhaled salbutamol therapy by the end of phase 1 compared with the control group (n = 34). Patients in the intravenous salbutamol group were ready for discharge from the emergency department 3.7 hrs earlier than those in the control group and were ready for discharge from the hospital 9.7 hrs earlier than controls. No significant side effects were found in either group. CONCLUSION: A single-dose intravenous salbutamol bolus of 15 &mgr;g/kg administered over 10 mins in the initial treatment of children with acute severe asthma in the emergency department has the potential to shorten the duration of severe attacks and reduce overall requirements for inhaled salbutamol maintenance.