Management of Acute Asthma Exacerbation in School-Aged Children
Severity Classification and Initial Assessment
- The British Thoracic Society defines severe asthma as requiring inability to complete sentences, pulse >110 bpm, respiratory rate >25/min, and PEF <50% predicted or best 1, 2, 4
- A child with a moderate exacerbation, characterized by speech normality, SpO2 95%, peak flow 60% of best, and mild wheeze, does not meet the criteria for severe asthma 1, 2, 3
Immediate Treatment Approach
- The British Thoracic Society guidelines recommend giving salbutamol via metered-dose inhaler (MDI) with spacer: 2 puffs repeated 10-20 times if needed, or nebulized salbutamol 5 mg 1, 2, 3
- The guideline specifically states that if there is no nebuliser, 2 puffs of β agonist via a large volume spacer should be given and repeated 10-20 times 1, 2
- Monitor response 15-30 minutes after treatment 1, 2, 3
Disposition and Follow-up
- If PEF improves to >75% predicted/best after treatment, step up usual treatment and arrange outpatient follow-up within 48 hours 1, 2
- If PEF is 50-75% predicted/best, give prednisolone 30-40 mg orally, step up usual treatment, and arrange follow-up within 48 hours 1, 2, 3
- If PEF remains <50% or severe features develop, consider hospitalization 1, 2