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 (after receiving the standard of care, 3 back to back nebulization (salbutamol and ipratropium bromide)) , the experimental group will be given epinephrine (1ml of 1:1000) as nebulization and the control group will receive salbutamol nebulization as 4th nebulization.
PRAM score with calculated before and at 60, 80, 100 min after the treatment.