Asthma Attack Discharge Advice - Salbutamol

What is an acute exacerbation of asthma?

A worsening of your child’s asthma caused by exposure to one of their triggers. These vary between children but the most common ones are coughs and colds, cold weather, cigarette smoke, pet fur or feathers and pollen.

Treatment over next few days

Over the next few days you should assess your child at least every 4 hours to make sure that they  are recovering from their attack of wheezing.

This is particularly important at night and first thing in the morning.

If they are breathless or wheezy

  • Give 2 puffs of blue inhaler one at a time using a spacer. Review their response after 10 minutes. If they are not improving give another 2 puffs and reassess. If they are still not getting better, repeat up to a maximum total dose of 10 puffs and reassess.
  • If you are still worried after this: Give up to another 10 puffs of blue inhaler one at a time using a spacer. Seek urgent help by calling 999 or attend your local Emergency Department

If they are not breathless or wheezy

  • They do not need their blue inhaler. Continue to review them at least every 4 hours.

You should continue your child’s normal preventer treatment(s) during an acute exacerbation of asthma.

If your child has any of the following:

  • Not improving despite using their inhaler according to their action plan
  • Breathing very fast, too breathless to talk, eat or drink 
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Breathing that stops or pauses
  • A harsh noise as they breathe in (stridor) present all of the time (even when they are not upset)
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)

Ring 999 for immediate help.

Follow your child's Personal Asthma Action plan OR Give 10 puffs of blue (salbutamol) reliever inhaler every 10 minutes until ambulance arrives.

Keep child in upright position and reassure them.

If your child has any of the following:

  • They need increased doses of their inhaler for more than 2-3 days
  • Breathing a bit faster than normal or working a bit harder to breathe
  • A harsh noise as they breathe in (stridor) only when upset
  • Dry skin, lips or tongue
  • Not had a wee in last 8 hours
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse and I am still worried

You need to contact a doctor or nurse today.

Please ring your GP surgery or NHS 111 – dial 111

Continue to follow your child’s action plan while seeking advice.

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features

If none of the above features are present

Watch them closely for any change and look out for any red or amber symptoms

Continue to follow your child’s action plan while seeking advice

If your child has other symptoms associated with their asthma attack, you might want to look at our information on sore throatcoughearachediarrhoea and vomiting or tummy ache or our other pathways.

If you are still worried, please see your local pharmacist or call NHS 111 - call 111

Children and young people who are unwell and have a high temperature should stay at home. They can go back to school, college or childcare when they no longer have a high temperature, and they are well enough to attend

Standard technique for use of inhaler and spacer

Choose appropriate sized spacer with mask (or mouthpiece if child is over 3 years with good technique and is not significantly short of breath).


  1. Shake the inhaler well and remove cap.
  2. Fit the inhaler into the opening at the end of the spacer.
  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal
  4. Press the inhaler once and allow the child to take
  5. slow breaths between each dose 5 Remove the inhaler and shake between every puff. Wait 1 minute between puffs.

Repeat steps 1 – 5 for subsequent doses
Plastic spacers should be washed before 1st use and every month as per manufacturer’s guidelines

Click here for videos on inhaler technique.

Follow up

If your child has been discharged from hospital, you should arrange for them to be seen in the next 48 hours by your GP or GP practice nurse.

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