Assess the severity: 

Moderate:  

 Peak expiratory flow rate: ≥50% best (or predicted if best not available) 

 Sats: ≥92% 

 Speech: normal 🗣

 Respiratory rate: 2 to 5y/o <40 and >5y/o ≤30 

 Pulse: 2 to 5y/o ≤140 and >5y/o 125 💓

Severe: 

 Peak expiratory flow rate: 33 to 50% best (or predicted if best not available) 

 Sats: ≥92% 

 Speech: too breathless to speak or feed & using accessory neck muscle 🗣

 Respiratory rate: 2 to 5y/o >40 and >5y/o >30 

 Pulse: 2 to 5y/o >140 and >5y/o >125 💓

Life threatening (ADMIT IMMEDIATELY): 

 Sats: <92% plus any of the following: 

 Peak expiratory flow rate: <33% best (or predicted if best not available) 

 Cyanosis 

 Poor respiratory effort 

 Confusion/agitation 

 Silent chest 👂

Management: 

Moderate:  

 No oxygen required ❌ 

 SALBUTAMOL (up to 10 puffs via spacer) 

 Consider PREDNISOLONE (20mg for 2 to 5y/o or 30 to 40mg for >5y/o for 3 to 5 days or until recovered) 💊

Severe: 

 OXYGEN required to maintain sats between 94 and 98% 

 SALBUTAMOL (2.5mg for 2 to 5y/o or 5mg for >5y/o, nebulised via oxygen/ up to 10 puffs via a spacer) 

 PREDNISOLONE (20mg for 2 to 5y/o or 30 to 40mg for >5y/o for 3 to 5 days or until recovered) 💊

Moderate and Severe: 

 Reassess patient 15 minutes later ⏱  

 If patient responds poorly to management, repeat bronchodilators then ADMIT 🏨

 If patient responds well to management: 

 Continue salbutamol, if this fails then ADMIT 🏨

 Follow up with patient within 2 days 

 Consider referring the patient to secondary care if they have more than one attack within 1 year 🏨

Life threatening: 

 OXYGEN required to maintain sats between 94 and 98% 

 SALBUTAMOL and IPRATROPIUM (2.5mg for 2 to 5y/o or 5mg for >5y/o of Salbutamol, and 0.25mg Ipratropium, nebulised via oxygen) 

 PREDNISOLONE (20mg for 2 to 5y/o or 30 to 40mg for >5y/o for 3 to 5 days or until recovered) or HYDROCORTISONE if patient is vomiting (50mg for to to 5y/o and 100mg for >5y/o) 💊

 ADMIT IMMEDIATELY 🏨

Hospital Admission:

The threshold for admission should be lower in the following circumstances: 

 The patient was recently admitted 🏨

 Attack occurs in the afternoon or evening 

 You are concerned about their social situation 

Post-admission: 

 Primary care follow-up within 48 hours following discharge: 

 Check symptoms  

 Measure peak flow 

 Check the patient’s inhaler technique and their understanding of inhalers 

 Ensure patient is familiar with their Personal Asthma Action Plan 

 Discuss triggers to avoid to reduce risk of future admission 🏨

 Refer for secondary care if life threatening or more than one attack within 1 year

Summary:

1. Acute asthma in children can be defined as: moderate, severe, or life-threatening
2. Management varies depending on how it is classified, increasing in intensity
3. Hospital admission threshold should be lowered if the patient was recently admitted, has the attack in the afternoon or evening, and if you are concerned about the child's social situation
4. After hospital admission, you must follow-up with the patient within 48 hours and make sure they are familiar with their Personal Asthma Action Plan