Primary Care Clinical Pathway for Acute Asthma
Contact provider with concerning chief complaint
- Nursing – Obtain VS: HR, RR, Temperature, Pulse Oximetry
- Provider – Visual/Respiratory Assessment
- Determine Level of Severity of Asthma Exacerbation
Notify MD/NP if severe work of breathing, pulse oximetry 95%
Place all patients in exam room visibly monitored by staff
Place all patients in exam room visibly monitored by staff
Mild
Little wheezing or work of breathing
Little wheezing or work of breathing
Moderate
Wheezing throughout expiration
or
Intercostal retractions
Wheezing throughout expiration
or
Intercostal retractions
Severe
Inspiratory and expiratory wheezing
or
No breath sounds, suprasternal retractions, abdominal breathing
Inspiratory and expiratory wheezing
or
No breath sounds, suprasternal retractions, abdominal breathing
Albuterol
Consider Oral Steroids
Consider Oral Steroids
Albuterol, 4 puffs
Oral Steroids
Oral Steroids
Activate 911
MD/NP/RN at bedside
Continuous HR, RR, pulse oximetry
Respiratory Assessment
MD/NP/RN at bedside
Continuous HR, RR, pulse oximetry
Respiratory Assessment
Reassess 15-30 minutes
Discharge if Mild
Discharge if Mild
Albuterol +
Ipratropium
Oral Steroids
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
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 2022
Authors: T. Bryant-Stephens, MD; K. Zsolway, MD; K. Gelman, MD; K. Filograna, MD; E. Everly, MD; J. Partner, RN
Revised: August 2022
Authors: T. Bryant-Stephens, MD; K. Zsolway, MD; K. Gelman, MD; K. Filograna, MD; E. Everly, MD; J. Partner, RN
Evidence
- 2020 Focused Updates to the Asthma Management Guidelines: Clinician's Guide
- Follow-up Care After an ED Visit
CHOP Program
Educational Media
Related Links