This section is intended for clinicians caring for children with asthma in primary care, community care, hospital or tertiary care setting. It outlines best practice examples of guidelines and pathways. Innovative whole pathways of care, including specialist outreach, and moving care closer to home to deliver all required services, are key to integrating care.

Guidelines

London Asthma Leadership and Implementation Group for CYP (LALIG) statements:

• PAAPs: LALIG has produced a suite of Personalised Asthma Action Plans (PAAPs) for use across London. These have drop down boxes so clinicians completing them can include the medication used and indicate the colour of the inhaler. In addition there is a logic function around the peak flow highlighting when individual levels are too low and what action should be taken, in conjunction with symptoms. PAAP 4-11 in colour, PAAP 4-11 in black & white (for printing if needed), PAAP 12-18 in colour, PAAP 12-18 in black & white. MART (Maintenance and Reliever Therapy) and AIR (anti-inflammatory reliever) PAAPs will be added when available.

• Salbutamol: The use of salbutamol weaning plans after an acute asthma attack is not recommended. Evidence suggests that higher use of short-acting beta-agonists (SABA) is associated with adverse clinical outcomes.  Standardised prescriptive salbutamol weaning plans may mask deterioration in asthma control, which could be life threatening. 

• Nebuliser: This case study from Barking Havering and Redbridge describes a near miss involving the use of a home nebuliser. The following letter was sent out by LALIG in response, warning that nebulisers and salbutamol nebules should only be prescribed for the treatment of asthma by secondary or tertiary care. The MHRA have produced guidance on this together with videos for health care professionals and families.

• Oximetry: There is evidence that pulse oximetry in people with brown or black skin tones may underestimate the level of hypoxia; the oximeter companies are aware of this and working on possible solutions. Therefore, clinicians should not rely on oximetry alone and assessments of people with asthma should include a thorough assessment including respiratory and pulse rate and lung function. Please find a statement on the use of oximetry for people with brown or black skin tones which has been agreed for London.
• The use of peak expiratory flow in personalised asthma action plans

National guidelines

• British guideline on the management of asthma SIGN
• NICE guidelines on management of asthma in children and young people
• National Paediatric Asthma Collaborative Secondary care guideline over  National Paediatric Asthma Collaborative Secondary care guideline under Management of acute exacerbation of asthma / wheeze primary care clinical assessment tool for children under two years (NHS England 
• Asthma Guidelines in Practice – A PCRS Consensus | Primary Care Respiratory Society (pcrs-uk.org)

Guidelines from London ICSs

• Asthma in children and young people (preschool to 17 years) A guide for SEL general practice

• Acute Wheezy Episode: Management for Children 2 – 5 Years Primary Care Clinical Pathway NCL

• Acute Asthma Attack: Management for Known Asthmatic Children (5 – 16 Years) Primary Care Clinical Pathway NCL

• North West London Children’s acute asthma/preschool wheeze guideline

Pathways

• Moderate Paediatric Asthma Attack Pathway – for use in children 5 yrs and over
• London’s integrated urgent care Clinical Assessment Service (CAS) have developed a Mild Paediatric Asthma Pathway for use in children aged 5 – 16 years old (GP only)