if child 2-5 years old

moderate asthma

• able to talk in sentences
• SpO2 ≥92%
• PEF ≥50% best or predicted
• heart rate - ≤140/min
• respiratory rate - ≤40/min

acute severe asthma

• can’t complete sentences in one breath or too breathless to talk or feed
• SpO2 <92%
• heart rate >140/min
• respiratory rate >40/min
• use of accessory neck muscles

life threatening asthma

SpO2 <92% and any one of the following in a child with severe asthma:

• silent chest
• cyanosis
• poor respiratory effort
• agitation
• confusion

immediate management

• β2 agonist 2–10 puffs via spacer and facemask (given one puff at a time inhaled separately using tidal breathing)
• give one puff of β2 agonist every 30–60 seconds up to 10 puffs according to response
• consider oral prednisolone 20 mg

immediate management

• oxygen via face mask
• 10 puffs of β2 agonist or nebulised salbutamol 2.5 mg
• oral prednisolone 20 mg

assess response to treatment 15 mins after β2 agonist

immediate management

• oxygen via face mask
• nebulise every 20 minutes with: salbutamol 2.5 mg +  ipratropium 0.25 mg
• oral prednisolone 20 mg or IV hydrocortisone 50 mg if vomiting

if poor response arrange admission

if poor response repeat β2 agonist and arrange admission

repeat β2 agonist via oxygen driven nebuliser whilst arranging immediate hospital admission

GOOD RESPONSE

• continue up to 10 puffs of nebulised beta2 agonistas needed, not exceeding 4 hourly
• if symptoms are not controlled repeat beta2 agonist and refer to hospital
• continue prednisolone for up to 3 days
• arrange follow-up clinic visit within 48 hours
• consider to referral to secondary care asthma clinic if 2nd attack within 12 months

POOR RESPONSE

• stay with patient until ambulance arrives
• send written assessment and referral details
• repeat beta2 agonist via oxygen-driven nebuliser in ambulance