Asthma is a chronic inflammatory disease of the lower respiratory tract that leads to acute episodes of bronchospasm leading to cough and wheezing.
Around 14-16% of Australian children are currently living with asthma.
The medical literature is changing the way we classify and treat young children with wheeze.
This guideline applies to children around 10 months of age and older and addresses the Emergency Department Management of acute asthma in the first hour of presentation.
Recent changes in practice
In the treatment of asthma/wheezing, the use of pressurised metered dose inhalers (pMDIs) with spacer devices has to a large extent superseded the use of nebulisers as the preferred means of delivery of inhaled aerosol solutions
Princess Margaret Hospital uses the small volume spacer for all ages
Potential triggers for an acute asthma exacerbation can include:
Allergy (there is a strong link between asthma and atopy)
Viral upper and lower respiratory tract infections
Evironmental: cigarette smoke (including passive smoking), air pollution, cold air
Keep reassessing the patient’s condition and their response to treatment
A deteriorating patient needs to be identified early and treated more aggressively
It is not necessary for all clinical criteria to be met for a patient to be considered “severe” or “critical”
Wheeze is not an indicator of severity
Asthma classification: infrequent or frequent intermittent, persistant
Previous Paediatric Intensive Care Unit admissions
All patients should be offered follow up with the Asthma Foundation. To do this ask the parent to sign the consent form and send in the internal mail to the Asthma Liaison Nurse. She will forward onto the foundation. You can advise the parent that an Education Officer will then contact the family at home.
A range of services are offered at the Foundation including:
Group Education sessions
Over-the-phone Education sessions
Individual Education sessions at the Asthma Foundation Centre or in certain metropolitan clinics
Health information (for carers)
Contributing factors – identify and discuss relevant environmental and allergy factors with the family:
Allergens – inhaled or ingested
Where possible give appropriate education and advice to the patient and family regarding allergen avoidance if warranted.
Asthma Action Plan – to be completed and explained by the Emergency Doctor for all patients with asthma prior to discharge – either the generic PMH Action Plan or a hand-written Action Plan can be used. Generic Action Plans are available in the Asthma Education Pack given to patients.
Discharge letter for the General Practitioner
Baseline observations include heart rate, respiratory rate, oxygen saturations, temperature.
Minimum of hourly observations should be recorded whilst in the emergency department.
Any significant changes should be reported immediately to the medical team.
A minimum of 4 hourly salbutamol should be given whilst the child is admitted to hospital.
Advise the doctor when the patient has reached 3 – 4 hourly without requiring salbutamol so the patient can be reviewed with a view to discharge.
Positioning the patient
Make sure the patient is sitting upright not lying flat to maximise respiratory function.
PMH ED Guideline : Asthma – last updated September 2014
Watts E, Borland M, Doyle S and Geelhoed G. Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial. Journal of Paediatrics and Child Health: 2015 Feb;51(2): 192-8. doi: 10.1111/jpc.12692. Epub 2014 July 14.