Acute exacerbation of asthma

Advice for professionals

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.

Asthma Action Plan

Keep this plan with you and take it every time you see the doctor or nurse at your GP surgery (or Hospital). This plan is for patients with asthma – your GP/doctor (or nurse) will fill it in and explain the different medicines to control your asthma. It will also show you how to recognise when the asthma or wheeze is getting worse and what to do about it. By taking steps early – acute attacks can usually be prevented.

Paediatric Pathway

Click here to view the acute asthma paediatric pathway. 
 

 

When should you worry?

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; if this continues for more than 5 days contact your GP

Self care

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

This guidance has been reviewed and adapted by healthcare professionals across South Yorkshire and Bassetlaw with consent from the Hampshire development groups.

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 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

For videos on using your child’s inhaler and spacer correctly see goo.gl/235DQf

Over the next few days, your child will need to be regularly given a blue (salbutamol) reliever inhaler.

Dose of blue (salbutamol) reliever inhaler via Spacer:

Today ....... puffs, ....... hourly for first ....... day(s)

Then ....... puffs, ....... hourly for next ....... day(s)

Then ....... puffs, ....... hourly until symptoms improve

after which your child should be back to normal and you should be able to stop the blue inhaler.

In the event that your child has been started on steroid tablets, these should be continued once daily (usual treatment course is 3 days).

If your child becomes increasingly breathless despite following the plan above, you should follow the instructions outlined in the table below.

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

  • Ensure your child always has access to their reliever (blue) inhaler and spacer
  • Start reliever treatment early at the start of a runny nose - 2 puffs 4 hourly
  • Remember to leave a spare reliever inhaler (with/without spacer) at school for your child and ensure that it is kept in date
  • Remember to take inhaler with you or your child on any trips away from home
  • Always use the correct inhaler device as prescribed for you or your child
  • Remember a spacer is the best way to deliver reliever treatment in an emergency
  • Remember to keep any follow up appointments and attend their annual GP asthma review
  • If your child has been discharged from hospital following an exacerbation, you should arrange for them to be seen in the next 48 hours by the GP/Practice nurse

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