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 feed
Heart rate > 140/min
Respiratory rate > 40/min
Use of accessory neck muscles	SpO2 <92%
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis

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

Moderate attack	Severe attack	Life-threatening attack
SpO2 > 92%
PEF > 50% best or predicted
No clinical features of severe asthma	SpO2 < 92%
PEF 33-50% best or predicted
Can't complete sentences in one breath or too breathless to talk or feed
Heart rate > 125/min
Respiratory rate > 30/min
Use of accessory neck muscles	SpO2 < 92%
PEF < 33% best or predicted
Silent chest
Poor respiratory effort
Altered consciousness
Cyanosis

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)