Current symptom control | Reliever (salbutamol 100 microg/actuation) | Maintenance ICS-containing treatment IF PRESCRIBED |
When child well (e.g. almost no symptoms, occasional symptoms mild with no visibly increased work of breathing) | Principle: Use child’s usual dose if symptoms occur | Principle: Continue usual daily dose as prescribed |
Sample instruction: When child has symptoms, give 2 puffs, one at a time using puffer and spacer. If symptoms do not improve within 4 minutes, give 2 more puffs. Before exercise, give 2 puffs using puffer and spacer. | Sample instruction for child using fluticasone propionate 100 microg twice daily:† 1 puff morning and night using puffer and spacer | |
When child not well (e.g. needing reliever more often than usual, night-time symptoms, waking with symptoms, or visibly increased work of breathing) | Principle: Increase dose taken on each occasion and give only when symptoms occur (not by the clock) | Principle: Short-term increase in ICS not recommended |
Sample instruction: Give 4 puffs, one puff at a time using puffer with spacer. If symptoms do not improve within 2–4 minutes, give 4 more puffs | Sample instruction: Keep giving usual daily dose. | |
If symptoms* worsening (e.g. needing reliever again within 3 hours, increasing breathing difficulty, e.g. sucking in above, below or around the rib cage, using abdominal muscles to push air out of lungs, breathing fast, shoulders bobbing up and down with breathing ) | Principle: Increase dose taken on each occasion and give only when symptoms occur (not by the clock) | Principle: Short-term increase in ICS not recommended |
Sample instruction: Give 12 puffs, one puff at a time using puffer and spacer. If symptoms do not improve within a few minutes, give 12 more puffs and call 000 for an ambulance. If difficult breathing recurs within 1 hour, give 12 more puffs and call 000 for an ambulance or take child to ED, even if symptoms get better. If difficult breathing recurs within 3 hours, give 12 more puffs and get urgent medical care, even if symptoms get better. | Sample instruction: Keep giving usual daily dose. |
Additional information
*Table shows only sample adjustments for reliever and maintenance ICS-containing treatment when asthma symptoms worsening. Asthma action plans also include other usual treatment such as medicines for comorbid allergic rhinitis, emergency instructions including when to call an ambulance, and instructions according to individual triggers and comorbidity (e.g. when to use adrenaline auto-injector).
† Example only – see Medicines guide for range of doses and inhalers.
⚠ Asthma action plans for children 6–11 years should not include instructions for parents to start oral corticosteroids without medical advice.