Immediate treatment of acute asthma in children 1–5 years in the ED

All of:

Can walk (for younger children, can move about)

Can speak in phrases (for younger children, can vocalise)

Moderate use of accessory muscles of neck or intercostal muscles/tracheal tug/subcostal recession

SpO₂ (room air) >94%

Any of:

Unable to complete sentences in one breath due to breathlessness

Significant use of accessory muscles of neck or intercostal muscles/tracheal tug/subcostal recession during inspiration

Obvious respiratory distress

SpO₂ (room air) ≤94%

Any of:

Reduced consciousness/collapse, exhaustion

Cyanosis

Poor respiratory effort

SpO₂ (room air) <90%

Poor respiratory effort, soft/absent breath sounds

Immediate treatment

Give salbutamol 2–6 actuations (100 microg per actuation) via pMDI and spacer (tidal breathing),   plus mask if needed

Arrange transfer to acute care

Give salbutamol 6 actuations (100 microg per actuation) via pMDI and spacer (tidal breathing), plus mask if needed

If patient cannot breathe through spacer with mask, give 2.5 mg nebule via nebuliser

Start oxygen supplementation if SpO₂<92% on room air

Titrate to target 92–96%

Arrange transfer to ICU

Give salbutamol 2 x 2.5 mg nebules via continuous nebulisation driven by oxygen

Maintain SpO₂ to target  92–96%