Asthma (Acute Exacerbation) PIL

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

  • Is this asthma, making a diagnosis and red flags
  • Standard technique for use inhalers
  • Personal asthma plan proforma Chronic asthma management Chronic management - Beat Asthm
  • National asthma Guidelines
  • Personal asthma plans
  • Asthma annual review proforma
  • Indications for referral to secondary care asthma services

Chronic asthma management

Chronic management - Beat Asthma

  • National asthma Guidelines
  • Personal asthma plans
  • Asthma annual review proforma
  • Indications for referral to secondary care asthma service

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 symptom

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.

This guidance is written by healthcare professionals from across Hampshire, Dorset and the Isle of Wight.

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 ensuring a good seal
  4. Press the inhaler once and allow the child to take 5 slow tidal breaths between each dose
  5. Remove the inhaler and shake between every puff

Repeat steps 2 – 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

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