Asthma

Treatment Targets

• Maintain SpO₂ >95% in mild to moderate exacerbations

• Maintain SpO₂ ≥92% in severe or critical presentations

• Aim to stabilise airway function promptly and prevent further deterioration

Mild/Moderate Asthma

• Give salbutamol via spacer: <6 yrs 6 puffs, ≥6 yrs 12 puffs

• Use 1 puff followed by 4 breaths, repeat every 20 min for up to 1 hr as needed

• Consider early oral corticosteroids if response is suboptimal

• Provide a calm environment to reduce anxiety and respiratory distress

Severe Asthma

• Administer salbutamol with ipratropium via spacer

• Salbutamol doses as for mild/moderate plus ipratropium <6 yrs 4 puffs, ≥6 yrs 8 puffs

• Switch to nebulised therapy if spacer is ineffective: <6 yrs salbutamol 2.5 mg + ipratropium 250 mcg, ≥6 yrs salbutamol 5 mg + ipratropium 500 mcg

• Give oral or IV corticosteroids promptly

• Provide oxygen to keep SpO₂ ≥92%

Critical Asthma

• Nebulise immediately with double-dose salbutamol

• <6 yrs salbutamol 2×2.5 mg + ipratropium 250 mcg, ≥6 yrs salbutamol 2×5 mg + ipratropium 500 mcg

• Consider continuous salbutamol if poor response

• Involve critical care if child remains in severe distress or shows exhaustion

Additional Management

• Corticosteroids: Prednisolone 1 mg/kg (max 50 mg) or IV hydrocortisone 4 mg/kg (max 100 mg) if vomiting

• Oxygen to maintain SpO₂ ≥92%

• IV magnesium sulfate 50 mg/kg (max 2 g) over 20 min for life-threatening attacks

• Ensure adequate hydration and correct any electrolyte imbalances

• Monitor serum potassium if frequent or continuous salbutamol is used

Monitoring

• Assess respiratory effort, wheeze, SpO₂, and heart rate regularly

• Observe for clinical improvement or signs of worsening airway obstruction

• Reassess after each treatment dose to guide ongoing therapy

• Escalate care and consider intubation if no significant response

• Review inhaler technique and arrange a written action plan before discharge