Inpatient Clinical Pathway for Children
with Acute Asthma Exacerbation
Child with Acute Asthma Exacerbation
- History & Physical
- Steroid Management
- Prednisone/Prednisolone Q12 hrs. Start 24 hrs after ED dose if dexamethasone given in ED
- Discontinue inhaled corticosteroid
- Management of FiO2 and SpO2
- Further Diagnostic Testing
- Determine severity level of exacerbation based on respiratory assessment
Initiate Discharge Planning:
- Case Management
- Asthma Education Plan
- Asthma Care Plan
- PCP Contact
Mild, Moderate, or Severe?
Severe
> 20 kg | 3 ml/hr (15mg/hr) |
> 10-20 kg | 2.25 ml/hr (11.25 mg/hr) |
5-10 kg | 1.5 ml/hr (7.5 mg/hr) |
Additional Medications
Consider Ipratropium Bromide
Prednisone / Prednisolone / Methylpred
Consider Ipratropium Bromide
Prednisone / Prednisolone / Methylpred
Assessment
Respiratory q 1 hour
HR, RR q 1 hour, PRN
Continuous pulse oximetry, CRM
Hydration status IV & PO
Respiratory q 1 hour
HR, RR q 1 hour, PRN
Continuous pulse oximetry, CRM
Hydration status IV & PO
Progression
Moderate assessment for 2 hours
Then advance to moderate
Moderate assessment for 2 hours
Then advance to moderate
Moderate
> 20 kg | 8 puffs q 2 hours |
10-20 kg | 6 puffs q 2 hours |
5-10 kg | 4 puffs q 2 hours |
Additional Medications
Discontinue Ipratropium Bromide
Continue Prednisone / Prednisolone
Discontinue Ipratropium Bromide
Continue Prednisone / Prednisolone
Assessment
Respiratory q 2 hours
HR, RR q 2 hours
Discontinue CRN
Pulse oximetry per protocol
Hydration Status IV & PO
Respiratory q 2 hours
HR, RR q 2 hours
Discontinue CRN
Pulse oximetry per protocol
Hydration Status IV & PO
Progression
Must be on RA (no oxygen requirement)
At 1st mild/moderate assessments (treat)
Assess in 2 hours then hourly x2 hours. Hold treatment if mild at 2 and 3 hours.
Must be on RA (no oxygen requirement)
At 1st mild/moderate assessments (treat)
Assess in 2 hours then hourly x2 hours. Hold treatment if mild at 2 and 3 hours.
Mild
First q 4 hours | Second q 4 hours (Home Dose) | |
---|---|---|
> 20 kg | 8 puffs | 2 puffs |
10-20 kg | 6 puffs | 2 puffs |
5-10 kg | 4 puffs | 2 puffs |
Additional Medications
Continue home dose every 4 hours
until discharge
Continue Prednisone
Restart / initiate ICS as needed
Continue home dose every 4 hours
until discharge
Continue Prednisone
Restart / initiate ICS as needed
Assessment
Respiratory q 4 hours
HR, RR q 4 hours
Pulse oximetry PRN
Oral intake, hydration status
Respiratory q 4 hours
HR, RR q 4 hours
Pulse oximetry PRN
Oral intake, hydration status
Progression
Discharge after home dose
Discharge after home dose
Worsening respiratory distress or symptoms/signs of tiring
Asthma Escalation Pathway
Asthma Escalation Pathway
After any change in status
(moderate, severe) reassessment every hour until tolerating new interval
(moderate, severe) reassessment every hour until tolerating new interval
Posted: June 2011
Reviewed: April 2020
Authors: C. Kenyon, MD; J. Zorc, MD; M. McCloskey, RN; J. Coyne, RT; E. Shelov, MD
Reviewed: April 2020
Authors: C. Kenyon, MD; J. Zorc, MD; M. McCloskey, RN; J. Coyne, RT; E. Shelov, MD
Evidence
- Common Medicaid Formulary Beta Agonists, Inhaled Steroids and Inhaled Steroid/LABAs
- Community Asthma Prevention Program (CAPP) Services and Eligibility
Educational Media
Related Links