Acute exacerbation of asthma

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
Acute asthma management

Please see our link to Beat Asthma for tips on diagnosis, resources for families and your online asthma action plans 

Asthma Diagnosis - Beat Asthma 

  • Is this asthma, making a diagnosis and red flags

  • standard technique for use inhalers

  • Personal asthma plan proforma

Also see Beat Asthma video Beat Asthma - How to use an aerochamber spacer with mask - YouTube

Chronic asthma management 

Chronic management - Beat Asthma

  • National asthma Guidelines

  • Personal asthma plans

  • Asthma annual review proforma

  • Indications for referral to secondary care asthma services

When should you worry?

If your child has any of the following:

  • 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
  • Breathing very fast or breathing that stops or pauses
  • Working hard to breathe, drawing in of the muscles below the rib, unable to talk or noisy breathing (grunting)
  • Becomes pale, blue, mottled and/or unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched, continuous cry or extremely agitated
  • Has a fit (seizure)
  • A temperature less than 36oC or temperature 38oC or more if baby is less than 3 months
  • Develops a rash that does not disappear with pressure and seems unwell (see the 'Glass Test')

You need urgent help. 

Call 999

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 has any of the following:

  • Blue (salbutamol) inhaler 2-5 puffs via a spacer is not lasting 4 hours
  • Cough or wheeze/tight chest during the day and night
  • Too breathless to run/play/do normal activities
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips, tongue or looking pale
  • Not had a wee or wet nappy in last 12 hours
  • Sleepy or not responding normally
  • Crying and unsettled
  • Not drinking
  • A temperature 39oC or above in babies 3-6 months
  • Temperature of 38oC or above for more than 5 days or shivering with fever (rigors)
  • Getting worse or you are worried about them

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 has none of the above:

Watch them closely for any change and look out for any red or amber symptoms

Additional advice is also available for families for help cope with crying in otherwise well babies

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 North East and North Cumbria 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 5 slow breaths between each dose or count to 10

  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

Videos on inhaler technique.

Asthma Attack - 1.jpg

Asthma Attack 2.jpg

  • Keep your child well hydrated by offering them lots to drink
  • Most children with coughs and colds do not require treatment with antibiotics. 
  • If your child seems to be in pain or discomfort, you can give your child Paracetamol or Ibuprofen, following the instructions on the container.
  • Do not give cough syrup. It is not recommended for children under 6 years. It can make children sleepy and does not help.
  • Try using saline nose drops or spray if your baby has a blocked nose.
  • For children over 2 years, vapour rubs (containing camphor, menthol and/or eucalyptus) may help children sleep better.

Standard technique for use of inhaler and spacer

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

How to use an aerochamber spacer with mask Beat Asthma video:

For more videos on using your child’s inhaler and spacer correctly see https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/#Videos

Looking after your child with 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

Where should you seek help?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  1. Many visits to A&E and calls to 999 could be resolved by any other NHS services.
  2. If your child's condition is not critical, choose another service to get them the best possible treatment.
  3. Help your child to understand – watch this video with them about going to A&E or riding in an ambulance

If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.

For information on common childhood illnesses go to What is wrong with my child?

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  1. Doctors/GPs can treat many illnesses that do not warrant a visit to A&E.
  2. Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.

Contacting the School Nurse

Some primary and secondary schools may have an allocated school nurse, however this can vary depending on the area  – telephone your child’s school to ask for the contact details of your school nursing team.

There is also a specialist nurse who works with families who choose to educate their children at home.

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:-

  • encouraging healthier lifestyles
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

North Cumbria

Northumberland

North Tyneside

Newcastle

Gateshead

South Tyneside

Sunderland

County Durham

Darlington

Hartlepool

Stockton

Middlesbrough

Redcar and Cleveland

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  1. Visit a pharmacy if your child is ill, but does not need to see a GP.
  2. Remember that if your child's condition gets worse, you should seek further medical advice immediately.
  3. Help your child to understand - watch this video with them about going to the pharmacy.

For information on common childhood illnesses go to What is wrong with my child?

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

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