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 is:

  • Too breathless to talk / eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every 4 hours
  • Confused and drowsy

Ring 999 for immediate help.

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 is:

  • Wheezing and breathless and blue (salbutamol) reliever inhaler 2-5 puffs is not lasting 4 hours
  • Having a cough or wheeze/tight chest during the day and night
  • Too breathless to run / play / do normal activities

Immediately contact your GP and make an appointment for your child to be seen that day face to face.

Increase blue (salbutamol) reliever inhaler 6-10 puffs every 4 hours

If your child starts to cough, wheeze or has a tight chest but can continue day to day activities

Give 2-5 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve.

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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