Home > Children & Young People > Respiratory >

Asthma in Children- acute (including wheeze)

Checked: 23-01-2023 by Rob Adams Next Review: 23-01-2024

Overview

This page is for children aged 12 months to 16 years with acute wheeze/ asthma. This includes children with an established diagnosis of asthma, first presentations of asthma, and wheezing during viral infections in preschool-aged children.

In all cases, an acute wheeze attack signals a risk for future attacks and this risk should be assessed and managed as well as the acute episode.

Please refer to the guidelines below:

Asthma: Acute Asthma Management in Children provided by Bristol Royal Hospital for Children.
Asthma action plans should be download and given to parents to support acute management:
- Child Asthma Plan
- Wheezy action plan
- Teenage Asthma Plan (Maintenance & Reliever Therapy - MART)
- Teenage Asthma Plan (Preventer Medications - non-MART)
School Asthma Action Plan - a guide for schools on how to manage a pupil with acute asthma (updated in September 2022)

See also the Asthma in Children - Chronic page.

For children aged less than 12 months then wheezing is usually associated with bronchiololitis and does not respond to treatment with steroids. Please see the Bronchiolitis page for details.

For adults aged 16 and over see the Asthma (adults) page.

Assessment and management

Assessment of acute wheeze/asthma:

Management in Primary Care

In children with mild-moderate wheeze/asthma give up to 10 puffs of Salbutamol by MDI + spacer & assess response (in < 5 years: 5-10 puffs, 1 puff per minute)

If there is a good response to treatment:
- Discharge home with b₂ agonist
- Consider 3 day course of once daily prednisolone (see notes on preschool wheeze above)
- Provide a written Wheezy action plan.
If there is a poor response refer to Chidren's ED on 0117 3428666

Red Flags

See assessment section above for advice on red flag signs and symptoms.

Children who have a severe episode of wheeze/asthma or who are not responding to treatment in primary care should be admitted to the Children's ED, or if unsure if admission is required then discuss with the ED helpline: Children's Urgent Care Referrals

Children with severe or life-threatening wheeze/asthma should be treated with salbutamol nebulisers and prednisolone (if possible) whilst arranging emergency transfer to CED. Call the CED team on 0117 3428666 for guidance on acute management whilst awaiting an ambulance.

CYP Asthma Community Clinic Pilot

From September 2022 – March 2023 there is a community clinic pilot in place at various locations across BNSSG for children and young people, aged 4-16 years, with less well controlled asthma, or where a diagnosis of asthma has not been made and in whom diagnostic testing and a clinical review would be helpful.

Update 31/01/2023: Due to the high number of referrals received for the community asthma clinic and the short term nature of the pilot, we unfortunately must pause from taking any further referrals at this time.

If you require support with a child or young person with asthma, please access the advice and guidance service available on ERS.

We would like to thank our primary care colleagues who have referred CYP over this period. We have received over 200 referrals across 36 practices with positive feedback from children and families. We will be completing an evaluation of the pilot which will be used to shape future models of care for children and young people with asthma.

Resources

BTS/SIGN guidelines on the management of asthma - 2019 - page has links to full guideline and quick guideline.

CKS guidelines on Asthma (all ages) - May 2021

BNSSG Asthma Prescribing guidelines for children are available in the Formulary Local Guidance section of Remedy.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.