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Asthma Clinical Pathway – Primary Care

Primary Care Clinical Pathway for Acute Asthma

Goals
Patient Education
Provider Resources
Child ≥ 6 mos with Asthma and Respiratory Complaint
 
 
Nursing
Contact provider with concerning chief complaint
 
 
  • Notify provider if severe work of breathing, SpO2 < 95%
  • Place all children in exam room, visibly monitored by staff
 
 
 
 
 
 
Mild
Moderate
Severe
  • Albuterol
  • Consider oral steroids
  • Albuterol, 4 puffs or albuterol + ipratropium, based on clinical situation
  • Strongly consider oral steroids
  • Supplemental oxygen for persistent SpO2 < 95%
  • Activate 911
  • Provider/nursing at bedside
  • Continuous HR, pulse oximetry
  • Frequent respiratory assessments
 
 
 
 
 
 
 
 
  • Reassess 15–30 mins
  • Discharge if mild
  • Albuterol + ipratropium
  • Oral steroids
  • Supplemental oxygen for persistent SpO2 < 95%
  • Severe distress
  • Impending respiratory failure
  • Albuterol + ipratropium
  • Code cart to room
  • Consider EpiPen
  • Oral Steroids
  • Supplemental oxygen for persistent SpO2 < 95%
 
 
 
 
 
Reassess 20–30 min
Repeat albuterol dose ×2 as clinically indicated
Repeat albuterol dose ×2 as clinically indicated
 
 
 
 
Mild
Moderate/Severe
 
 
 
 
Discharge
Refer to ED
Medication Weight, Kg Dose
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
  • ×3 doses
> 10
  • 500 mcg (2.5 mL)
  • Give with albuterol dose
  • ×2 doses
Dexamethasone
Preferred oral steroid
Mild-moderate flare, repeat in 24–48 hrs, crush tablet with cherry syrup, juice, or yogurt		 5–8 4 mg
> 8–12 6 mg
> 12 8 mg
Prednisone  
  • 1–2 mg/kg PO
  • Max 60 mg
Epinephrine (IM) 5–24 EpiPen Jr: 0.15 mg/0.3 mL
≥ 25 EpiPen: 0.3 mg/0.3 mL