Primary Care Clinical Pathway for Acute Asthma

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
Little wheezing or work of breathing
Wheezing throughout expiration
Intercostal retractions
Inspiratory and expiratory wheezing
No breath sounds, suprasternal retractions, abdominal breathing
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 +
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
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 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