Acute asthma in a child

Risk factors

  • Recent hospital admission
  • Previous severe attack
  • Young age
  • Known cardio-respiratory illness
  • Significant co-morbidity
  • Already taking oral steroids
  • Concerns over ability to cope at home
  • Food allergy

Consider other diagnoses if

  • Pneumonia – fever, productive cough
  • Epiglottitis – dysphagia
  • Croup – inspiratory stridor
  • Hyperventilation – peripheral tingling
  • Asymmetry on auscultation
  • Excessive vomiting
  • Anaphylaxis

 

Clinical management

  • Investigations
    • Peak flow
      • Moderate >50% of predicted
      • Amber – 33 – 50% of predicted
      • Life threatening – <33% of predicted
  • Treatment
    • Mild-Moderate
      • Up to 10 puffs of salbutamol via spacer with facemask
      • Prednisolone OD for three days
      • Re-assess after 15-30 minutes
    • Severe
      • 999
      • High flow oxygen, 10 puffs salbutamol via spacer/nebuliser, prednisolone
  • Follow-up / Safety-net
    • Check inhaler technique
    • See again in 48hr

 

Prednisolone doses

  • <2 years old – 10mg OD
  • 2-5 years old – 20mg OD
  • 5-7 years old – 30mg OD
  • >7 years old – 40mg OD