Emergency departments

This section is intended for clinicians caring for children with asthma in a hospital or tertiary care setting. It outlines examples of best practice in the assessment, treatment and ongoing management of children and young people with asthma in an acute setting.

Asthma management in emergency departments

Acute asthma is a relatively common emergency in children and young people and should be treated as severe until proven otherwise. Severe asthma in children is the third most common cause of hospital admission and the most common cause of admission to paediatric intensive care unit (PICU)   It is essential to recognise the severity of an acute asthma attack by observing the degree of a child’s breathlessness and whether they are using their accessory muscles, if they have a wheeze, what their pulse and respiratory rate is and their level of distress.

Prompt action to manage asthma exacerbations is required with the right care, in the right place, at the right time by clinicians that are trained in asthma. Rapid access to specialist care when needed is required.

  • The department should have an identified lead for asthma who helps to develop excellent streamlined processes and best practice for admission and discharge.
  • Access to short acting bronchodilators via metered dose inhalers via a spacer will prevent over reliance on hospital care.  If nebuliser therapy is required assessment should be by a consultant and it should be administered by an oxygen device not air driven
  • Systemic steroids within 1 hour of presentation

Sample guidance

  Clinical assessment of acute asthma for a child aged 2-16 years

  Kings College Hospital pro forma and discharge bundle

  Acute wheeze guide – Whittington Health