Paeds Acute Asthma Algorithm

Mild · PAS 5-7

Complete all of the above within 60min of triage

VITAL SIGNS & PAS q 60min

If PAS increase (8-11) — Move to "Moderate pathway"

If PAS remained the same or less (PAS 5-7) — Consider discharge; Provide discharge plan; Short course prednisolone

Moderate · PAS 8-11

MDI Salbutamol now and every 20min (via spacer) X 3
or
Oxygen driven Nebulised Salbutamol
Administer oxygen to maintain SpO2 94-98%
Give oral corticosteroid AS SOON AS POSSIBLE after 1st salbutamol dose (within 60 min of triage)

Complete all of the above within 60min of triage

VITAL SIGNS & PAS q 30-60 min

If PAS increase (12-15) — Move to "Severe pathway"

If PAS remained the same (PAS 8-11) — Consider admission; Move to "Severe pathway"

If PAS reduced (5-7) — Consider discharge; Provide discharge plan; Short course prednisolone

Severe · PAS 12-15

Administer oxygen to maintain SpO2 94-98%
Oxygen driven Nebulised Salbutamol + Ipratropium Bromide + Steroid now and every 20min X 3
Give oral/IV corticosteroid AS SOON AS POSSIBLE (within 20 min of triage)
Consider IV access or ABG

Complete all of the above within 60min of triage

VITAL SIGNS & PAS q 20-30 min

If PAS increase — Move to "Life-threatening respiratory failure pathway"

If PAS remained the same — Repeat the same with oxygen driven nebulised Salbutamol + Ipratropium every 20min X 3; IV MgSO4 / SC Terbutaline

If PAS improving (8-11) — Move to "Moderate pathway"

Life-threatening respiratory failure

To assess STAT

Lethargy, cyanosis, decreasing respiratory effort and/or rising pCO2

Administer 100% oxygen
Support ventilation (DO NOT OVERVENTILATE)
Continuous cardiopulmonary monitoring
Oxygen driven Nebulised Salbutamol + Ipratropium Bromide + Steroid now and back to back/continuous every 20min X 3
Give systemic corticosteroid AS SOON AS POSSIBLE
IV MgSO4 (caution: can cause low BP) or SC Terbutaline
Obtain IV access & ABG

VITAL SIGNS & PAS q 20

If no improvement — Add IV Salbutamol (slow bolus +/- infusion, need continuous ECG monitor for infusion); IV fluid; CXR; PICU/PHDU admission

Drug Dosages for Medications used in Acute Asthma

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Source

Paediatric Protocols for Malaysian Hospitals, 5th Edition. Ministry of Health Malaysia.