Primary Care Clinical Pathway for Acute Asthma

MUST Notify MD/NP if severe work of breathing, pulse oximetry < 95%
Place all patients in exam room visibly monitored by staff
Mild: PASS score 0
Moderate: PASS score 1-3
Severe: PASS score 4-6
Albuterol
Consider Oral Steroids
Albuterol + Ipratropium
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
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 2015, July 2017 (Reviewed), October 2019
Authors: T. Bryant-Stephens, MD; K. Zsolway, MD; K. Gelman, MD; K. Filograna, MD; E. Everly, MD; J. Partner, RN