Primary Care Clinical Pathway for Acute Asthma

Goals
Patient Education
Provider Resources
Child ≥ 6 months with Asthma and Respiratory Complaint
COVID-19 Modifications
Nursing – Focused History Questions
Contact provider with concerning chief complaint
Notify MD/NP if severe work of breathing, pulse oximetry < 95%
Place all patients in exam room visibly monitored by staff
Mild
Little wheezing or work of breathing
Moderate
Wheezing throughout expiration
or
Intercostal retractions
Severe
Inspiratory and expiratory wheezing
or
No breath sounds, suprasternal retractions, abdominal breathing
Albuterol
Consider Oral Steroids
Albuterol, 4 puffs
Oral Steroids
Activate 911
MD/NP/RN at bedside
Continuous HR, RR, pulse oximetry
Respiratory Assessment
Reassess 15-30 minutes
Discharge if Mild
Albuterol +
Ipratropium
Oral Steroids
  • Severe Distress
  • Impending
    Respiratory Failure
  • Epi-pen
  • Albuterol + Ipratropium
  • Oral Steroids
Reassess 20-30 min
Repeat dose x2 as clinically indicated
Repeat dose x2 as clinically indicated
Mild
Moderate/Severe
Discharge
Refer to ED
Kg Medication
Albuterol Weight-based Dosing
> 5 4 puffs
Nebulizer 1 vial with 0.083% solution
(2.5 mg/3 mL)
Ipratropium Weight-based Dosing
5-10 250 mcg (1.25 mL)
Give with albuterol dose and 1 mL NS
x 3 doses
> 10 500 mcg (2.5 mL)
Give with albuterol dose
x 2 doses
Prednisone/Methylprednisolone
  Prednisone 1-2 mg/kg PO
Max 60 mg
Methylprednisolone 1 mg/kg IM
Max 30 mg
Dexamethasone: Mild-moderate flare, repeat in 24-48 hours, crush tablet with cherry syrup, juice, or yogurt
5-8 4 mg
8-12 6 mg
> 12 8 mg
Epinephrine (IM)
5-25 Epi-pen Jr: 0.15 mg/0.3 mL
> 25 Epi-Pen: 0.3 mg/0.3mL
Posted: September 2014
Revised: August 2022
Authors: T. Bryant-Stephens, MD; K. Zsolway, MD; K. Gelman, MD; K. Filograna, MD; E. Everly, MD; J. Partner, RN