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Asthma Clinical Pathway – Inpatient

Inpatient Clinical Pathway for Children
with Acute Asthma Exacerbation

Child with acute asthma exacerbation
following ED treatment
 
 
 
 

Initiate Discharge Planning

 
 
Determine severity based on respiratory assessment
 
 
 
 
 
 
Mild
Albuterol Dosages
  First q4hr Second q4hr
Home Dose
> 20 kg 8 puffs 2 puffs
> 10–20 kg 6 puffs 2 puffs
5–10 kg 4 puffs 2 puffs
  • Continue home dose q4hr until discharge
  • Additional Medications
    • Discontinue inhaled corticosteroid
    • Prednisone/prednisolone
    • Restart/initiate controller medications as needed
  • Assessment
    • Respiratory q4hr
    • HR, RR q4hr
    • Pulse oximetry PRN
    • Oral intake, hydration status
  • Progression
    • Discharge after home dose
 
 
Moderate
Albuterol Dosages
> 20 kg 8 puffs q2hr
> 10–20 kg 6 puffs q2hr
5–10 kg 4 puffs q2hr
  • Additional Medications
  • Assessment
    • Respiratory q2hr
    • HR, RR q2hr
    • Discontinue cardiorespiratory monitor
    • Pulse oximetry q2hr
    • Hydration status, IV and PO
  • Progression
    • No supplemental oxygen requirement
    • At 1st mild/moderate assessments, treat
    • Assess in 2 hrs then hourly x2
    • Hold treatment if mild at 2 and 3 hrs
 
 
Severe
Continuous Albuterol Dosages
> 20 kg 15 mg/hr (3 mL/hr)
> 10–20 kg 11.25 mg/hr (2.25 mL/hr)
5–10 kg 7.5 mg/hr (1.5 mL/hr)
 
 
 
 
Worsening respiratory distress or symptoms/signs of tiring, variance to next pathway severity level

 

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