Asthma | Notion

Acute Exacerbation

Children with severe or life threatening asthma should be transferred immediately to hospital.

Moderate attack	Severe attack	Life-threatening attack
SpO2 > 92%No clinical features of severe asthma	SpO2 < 92%Too breathless to talk or feedHeart rate > 140/minRespiratory rate > 40/minUse of accessory neck muscles	SpO2 <92%Silent chestPoor respiratory effortAgitationAltered consciousnessCyanosis

Attempt to measure PEF in all children aged > 5 years.

Moderate attack	Severe attack	Life-threatening attack
SpO2 > 92%PEF > 50% best or predictedNo clinical features ofsevere asthma	SpO2 < 92%PEF 33-50% best or predictedCan't complete sentences in one breath or too breathless to talk or feedHeart rate > 125/minRespiratory rate > 30/minUse of accessory neck muscles	SpO2 < 92%PEF < 33% best or predictedSilent chestPoor respiratory effortAltered consciousnessCyanosis

For children with mild to moderate acute asthma:

Bronchodilator therapy

give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital

Steroid therapy

Age	Dose as per BTS	Dose as per cBNF
2 - 5 years	20 mg od	1-2 mg/kg od (max 40mg)
> 5 years	30 - 40 mg od	1-2 mg/kg od (max 40mg)