Current symptom control | Reliever (salbutamol 100 microg/actuation) | Maintenance ICS 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: 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 50 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) | 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 6 puffs, one puff at a time using puffer and spacer. If symptoms do not improve within a few minutes, give 6 more puffs and call an ambulance. If difficult breathing recurs within 1 hour, give 6 more puffs and call an ambulance or take child to ED, even if symptoms get better. If difficult breathing recurs within 3 hours, give 6 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 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)
†See Medicines guide for range of inhalers and doses
⚠ Asthma action plans for children 1–5 years should not include instructions to start oral corticosteroids. Systemic corticosteroid treatment in this age group is indicated only for exacerbations severe enough to require hospital admission.