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GuidelinesPEML (Paeds Hospital STG)

Persistent Asthma

Mild persistent asthma Moderate persistent asthma Severe persistent asthma Referral MILD PERSISTENT ASTHMA  When needed for acute exacerbations: ß 2 -agonist (short-acting), e.g.: Salbutamol, inhalation, 100–200 µg , as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved. PLUS For daily maintenance treatment: Low dose inhaled corticosteroids

Mild persistent asthma

Moderate persistent asthma

Severe persistent asthma

Referral

MILD PERSISTENT ASTHMA 

When needed for acute exacerbations:

  • ß2-agonist (short-acting), e.g.:
    • Salbutamol, inhalation, 100–200 µg, as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved.

PLUS

For daily maintenance treatment:

  • Low dose inhaled corticosteroids, e.g.:
    • Beclomethasone or budesonide, inhalation, 50–100 µg, 12 hourly using a metered-dose inhaler with a spacer device.

MODERATE PERSISTENT ASTHMA

To relieve symptoms:

  • ß2-agonist (short-acting), e.g.:
    • Salbutamol, inhalation, 100–200 µg, as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved.

PLUS

  • Regular anti-inflammatory treatment with medium-dose inhaled corticosteroids:
    • Beclomethasone or budesonide, inhalation, 100–200 µg, 12 hourly using a metered-dose inhaler with a spacer device.

OR

  • In children > 6 years with multiple allergies on other steroid formulations, low-dose inhaled corticosteroids plus long-acting beta agonist (LABA) e.g.:
    • Fluticasone plus salmeterol by inhalation, 12 hourly. Specialist initiated.

Metered dose inhaler:

  • Fluticasone/salmeterol, 25/50 MDI, 2 puffs 12 hourly.

OR

  • Fluticasone/salmeterol 25/125 MDI, 2 puffs, 12 hourly.

OR

Accuhaler:

  • Fluticasone/salmeterol 50/100, 1 inhalation, 12 hourly.

OR

  • Fluticasone/salmeterol 50/250, 1 inhalation, 12 hourly.

SEVERE PERSISTENT ASTHMA

To relieve symptoms:

  • ß2-agonist (short-acting), e.g.:
    • Salbutamol, inhalation, 100–200 µg, as required 3–4 times daily using a metered-dose inhaler with a spacer device until symptoms are relieved.

PLUS

  • Low-dose inhaled corticosteroids plus LABA, e.g.:
    • Fluticasone plus salmeterol, inhaled, 12 hourly. Specialist Initiated.

Metered dose inhaler:

  • Fluticasone/salmeterol, 25/50 MDI, 2 puffs 12 hourly.

OR

  • Fluticasone/salmeterol 25/125 MDI, 2 puffs, 12 hourly.

OR

Accuhaler:

  • Fluticasone/salmeterol 50/100, 1 inhalation, 12 hourly.

OR

  • Fluticasone/salmeterol 50/250, 1 inhalation, 12 hourly.

REFERRAL

  • Diagnostic uncertainty.
  • After a life-threatening episode.
  • Unstable or difficult to control asthma.
  • Asthma interfering with normal life, despite treatment.
  • Severe persistent asthma not responding to therapy.

Suggested reference peak expiratory flow (PEF) values for children:

Height (cm) PEF PEF
Caucasian African*
Male Female Male Female
100 127 142 120 126
101 131 145 124 130
102 135 149 128 133
103 138 152 131 137
104 142 156 135 140
105 146 159 139 144
106 150 163 143 148
107 154 166 147 151
108 158 170 151 155
109 162 174 155 159
110 166 178 159 163
111 170 182 163 167
112 175 185 168 171
113 179 189 172 175
114 184 193 176 179
115 188 197 181 184
116 193 202 186 188
117 197 206 190 192
118 202 210 195 197
119 207 214 200 201
120 212 218 205 206
121 217 223 210 210
122 222 227 215 215
123 227 232 220 220
124 232 236 226 225
125 237 241 231 230
126 243 245 236 235
127 248 250 242 240
128 254 255 248 245
129 259 259 253 250
130 265 264 259 255
131 271 269 265 260
132 276 274 271 266
133 282 279 277 271
134 288 284 283 277
135 294 289 289 282
136 300 294 295 288
137 307 299 302 293
138 313 304 308 299
139 319 309 315 305
140 326 315 322 311
141 332 320 328 317
142 339 325 335 323
143 345 331 342 329
144 352 336 349 335
145 359 342 356 342
146 366 348 363 348
147 373 353 371 354
148 380 354 378 361
149 387 365 386 368
150 395 371 392 374
151 402 377 401 381
152 410 382 409 388
153 417 388 417 395
154 425 394 425 402
155 433 401 433 409
156 440 409 441 416
157 448 413 442 423
158 456 419 458 430
159 464 426 466 437
160 473 432 475 445
161 481 438 484 452
162 489 445 492 460
163 498 451 501 468
164 506 458 510 475
165 515 465 520 483
166 524 471 529 491
167 533 478 538 499
168 542 485 548 507
169 551 492 557 515
170 560 499 567 523
171 569 506 577 532
172 578 513 587 540
173 588 520 597 548
174 597 527 607 557
175 607 534 617 566
176 617 541 627 574
177 626 549 638 583
178 636 556 648 592
179 646 563 659 601
180 657 571 670 610

*Based on African American data.

For optimal control 80% of the predicted peak flow is required.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 15: Respiratory System,  15.4 Conditions With Predominant Wheeze,  15.4.2 Asthma, Chronic

Drugs mentioned

NeoHealth® ID 20577 · updated 5/28/2023