The attached guidance replaces the previous version of the Paediatric Emergency Medicine Guidance Asthma Guidelines and is valid for the duration of the COVID-19 crisis.
These updated guidelines are to reduce as far as possible nebulization (and associated aerosolization) during the Covid-19 crisis.
Author: Prof. Micheal Levin (Allergologist at RXH)
Acknowledgements: Prof Sharon Kling (TBH) Prof Heather Zar (UCT)
Click here for Mild to Moderate Asthma Management during COVID-19 crisis
Click here for Severe Asthma Management during COVID-19 crisis
MANAGEMENT OF ACUTE SEVERE ASTHMA
ASSESS ASTHMA SEVERITY |
Moderate exacerbation
SpO2 ≥92%
- No clinical features of severe asthma
NB: Always treat according most severe features
| Severe exacerbation
SpO2 ≥92%
- Too breathless to talk or eat
- Heart rate >120/min
- Respiratory rate >40/min (<5 years) or >30/min (>5 years).
- Use of accessory resp muscles
| Life threatening asthma
SpO2 <92% plus any of:
- Silent chest
- Poor respiratory effort
- Agitation
- Altered consciousness
- Cyanosis
|
TREAT APPROPRIATELY |
- β2 agonist MDI 2 puffs
- Repeat as needed up to 10 puffs
- Children < 5 years use spacer ±mask
- Consider Prednisone 1-2 mg/kg PO
| - Oxygen via face mask/nasal prongs
- Nebulised Salbutamol (Ventolin) or Fenoterol (Berotec) 2ml:2ml saline Repeat every 30 minutes
- If not responding add Ipratropium bromide (Atrovent) 4hrly 2ml:2ml
- Prednisone 2mg/kg PO stat and daily for 5-10days or hydrocortisone 4mg/kg/IV stat and 2mg/kg/dose IV 6h
| - Inform Paediatrician / Paeds ICU.
- Oxygen via face mask/nasal prongs.
- Nebulised Salbutamol (Ventolin) or Fenoterol (Berotec) 2ml:2ml saline Repeat every 20-30 min
- Add Ipratropium bromide (Atrovent) 4hrly
- Prednisone 2mg/kg PO stat and daily for 5-10 days or hydrocortisone 4mg/kg/IV stat and 2mg/kg/dose IV 6h
Not responding
- Salbutamol IV loading dose 15 mcg/kg over 10 min. If needed cont infusion 0.2mcg/kg/min, increase by 0.1 mcg/kg every 15 minutes to a max of 2mcg/kg/min.
- Magnesium Sulphate 25-75mcg/kg IV over 20 minutes.
Not responding
- PICU with ECG monitoring.
- Aminophyline, IV, 5 mg/kg, loading dose administered over 20–30 minutes. Follow with 1mg/kg/hour infusion.
|
ASSESS RESPONSE TO TREATMENT
|
| Responder
| Non-responder
|
PERF
| improvement >20% OR >80% (best/predicted)
| improvement <20% OR <80% (best/predicted)
|
Respiratory rate
| < 40/minute
| > 40/minute
|
Retractions
| absent
| present
|
Speech
| normal
| impaired
|
Feeding
| normal
| impaired
|