Inpatient Clinical Pathway for Children
with Acute Asthma Exacerbation

Goals and Metrics
Patient Education
Sample Patient Progression
Pathway Documentation
Child with Acute Asthma Exacerbation
Initiate Discharge Planning:
  • Case Management
  • Asthma Education Plan
  • Asthma Care Plan
  • PCP Contact
Mild, Moderate, or Severe?
Severe
Continuous Albuterol Dosages
> 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
Assessment
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
Albuterol Dosages
> 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
Assessment
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.
Mild
Albuterol Dosages
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
Assessment
Respiratory q 4 hours
HR, RR q 4 hours
Pulse oximetry PRN
Oral intake, hydration status
Progression
Discharge after home dose
Worsening respiratory distress or symptoms/signs of tiring
Asthma Escalation Pathway
After any change in status
(moderate, severe) reassessment every hour until tolerating new interval
Discharge Criteria
Posted: June 2011
Reviewed: April 2020
Authors: C. Kenyon, MD; J. Zorc, MD; M. McCloskey, RN; J. Coyne, RT; E. Shelov, MD