An asthma clinical pathway is a task-oriented care plan that details essential steps in the care of patients with asthma and describes the patient's expected clinical course.
ED Pathway for Evaluation/Treatment
of Children with Asthma
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Respiratory Arrest
Imminent
To resuscitation room
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Mild
Moderate
Severe
Albuterol 2-4 puffs with spacer
Discharge
Prednisone/prednisolone
Albuterol unineb x 3 + Ipratropium
or if not able to tolerate unineb:
Albuterol MDI puffs x 3 w/o Ipratropium
Consider terbutaline
Prednisone/Methylprednisolone
Albuterol nebs x3 + Ipratropium
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ASSESS after completion of β-agonist
Considerations for further diagnostic testing
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Reassess after 1 hour
Repeat albuterol via Unineb/Aeroneb
(no ipratropium) Consider admission
Continuous albuterol
IV Mg bolus + NS
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Severe
Concern for Resp Failure
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Continuous albuterol
IV Mg bolus (if not given)
Consider terbutaline
SQ/IV bolus (no infusion)
Admit to ICU
Mod/Severe
Needs continuous albuterol
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Continuous albuterol
Consider IV mg bolus + NS
Admit to inpatient floor
Moderate
Needs q2h treatment
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Q2hr albuterol
Admit to floor/EDECU
Reassess
Albuterol Weight-based Dosing
Kg Unit Dose (0.5%) MDI Puffs Continuous
5-10 2.5 mg (0.5 mL) 4 7.5 mg/hr
>10-20 3.75 mg (0.75mL) 6 11.25 mg/hr
>20 5 mg (1.0 mL) 8 15 mg/hr
Ipratropium Weight-based Dosing
5-10 500 mcg over 1 hr in unineb or
250 mcg q20 min x 2
   
>10 1000 mcg over 1 hr in unineb or
500 mcg q20 min x 2
   
Prednisone/Methylprednisolone
  2 mg/kg p.o./IV, MAX 60 mg    
Magnesium Sulfate
  50 mg/kg, MAX 2 g    
Terbutaline
 

Subcutaneous:
  0.01 mg(mL)/kg MAX 0.25 mg (0.25 mL)

Bolus
 10 mcg/kg
 (Range 2-10 mcg/kg) MAX 750 mcg

Infusion (consider intermittent boluses as alternative)
  Starting dose 0.4 mcg/kg/min
  (Range 0.4 mcg/kg-3 mcg/kg/min)
  Titrate to Max 3 mcg/kg/min

Posted: October 2005
Revised: November 2011, September 2013
Authors: J. Zorc MD, R. Scarfone MD, AM Reardon CRNP, N. Stroebel CRNP, W. Frankenberger RN, L. Tyler RT, D. Simpkins RT