Clinical management of acute paediatric asthma on the wards

CHILD AND ADOLESCENT HEALTH SERVICE
PRINCESS MARGARET HOSPITAL FOR CHILDREN
CLINICAL MANAGEMENT OF ACUTE PAEDIATRIC ASTHMA ON THE WARDS
QUICK GUIDE
ASSESSMENT: Reassess severity on arrival to ward
Select the highest category that matches patients’ symptoms to establish severity and treatment required. Modify management as the patient improves, as outlined below. MILD ASTHMA
MODERATE ASTHMA
SEVERE ASTHMA
MEDICAL REVIEW
TREATMENT
Via face mask if O2 Saturation <92%, or otherwise clinically indicated Short acting 2 agonist 3 to
Short acting 2 agonist 2 to
Short acting 2 agonist ½
to 2 hourly
Consider switching to nebulised salbutamol:
If patient unable to cooperate with spacer or is deteriorating Dose: < 6 years – 2.5 mg/2.5 mL salbutamol nebule (do not dilute)  6 years – 5 mg/2.5 mL salbutamol nebule (do not dilute) Oral Corticosteroid
Oral/IV Corticosteroid
Oral Prednisolone 1mg/kg
Oral Corticosteroid
OR
Review/recommence
IV Hydrocortisone 4mg/kg 6
inhaled Prophylaxis
Review/recommence
inhaled Prophylaxis
about the administration, absorption or retention of oral medication) Asthma Quick Guide – Issued Nov 2008 Updated May 2009 Refer to Full Guideline for further This document should be read in conjunction with disclaimer in the introduction to these guidelines

Frequency of nursing observations depends on patients’ clinical status. Nursing Staff to
inform medical staff of clinical deterioration as indicated by one or more of the following:
 Increased work of breathing  Increasing O2 saturations / increasing oxygen requirement Any child on half on ½ hourly salbutamol requires medical review every 2-3 hours. If not responding to ½ hourly salbutamol and oral/IV corticosteroid for urgent medical review & discuss with consultant. See “Children not responding to standard asthma treatment” in full guideline. INVESTIGATIONS
 Allergy Testing – Consider in atypical asthma, recurrent asthma with no obvious viral
trigger, history of atopy (e.g. asthma & allergic rhinitis)  Spirometry with bronchodilator response if > 5 years – Arrange as an outpatient if
 Chest Xray – Not routinely required. May be required if evidence of a complication, not
responding to treatment or concerns regarding deterioration. Discuss with registrar/consultant if considering.  Nasopharyngeal Aspirate – Only when a specific viral/atypical diagnosis needs to be
considered and if it will alter management EDUCATION AND DISCHARGE PLANNING commences on admission
 Ensure parent & child demonstrate explain correct care (+/- mask if required)  Arrange discharge letter & copy of action plan  Arrange medical follow up with GP & Give & explain discharge medications (including spacer +/- improvement within 48 hours of discharge Paediatrician follow up indicated by one or more of
Consid Referral for:
Asthma not controlled on total daily dose of hospitalisations or ED presentations with asthma; medical conditions or psychosocial frequent courses of oral corticosteroids; FIT FOR DISCHARGE IF:
 No significant audible wheeze with good  Observations within acceptable range air entry   Education & discharge planning completed Tolerating 3-4 hourly bronchodilator via spacer and metered dose inhaler Asthma Quick Guide – Issued Nov 2008 Updated May 2009 Refer to Full Guideline for further This document should be read in conjunction with disclaimer in the introduction to these guidelines

Source: http://www.pmh.health.wa.gov.au/development/manuals/clinical_practice_guidelines/documents/asthma_quick-guide.pdf