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
After any change in status
(moderate, severe) reassessment every hour until tolerating new interval
Posted: June 2011
Revised: September 2013, November 2013, September 2015, November 2016, February 2018
Authors: C. Kenyon, MD; J. Zorc, MD; M. Dunn, MD; M. McCloskey, RN; J. Coyne, RT; E. Shelov, MD