Acute wheeze in children 2 years and older: assessment and management (623)

• Has the patient previously received IV therapy for wheeze management?
  
  
• Has the patient been admitted to the PICU previously for respiratory illness?
  
  

If YES to any of the above then patient should be discussed with on call Paediatric Registrar prior to discharge.

Salbutamol MDI + Spacer – Initial therapy = 10 puffs.  (100mcg per puff)

Oxygen – minimum 6 l/min via non-rebreather mask

IV MEDICATION
(To be prescribed as per the Escalation to IV therapy care pathway)

• Patient maintaining saturations > 94% in air
• Tolerating 3hrly multidosing        

Patients with MILD asthma at 1^st assessment can be discharged after Salbutamol without being monitored for 4 hours

• Discharge Checklist Completed
• No red flag features
• If presenting with interval symptoms medication reviewed and consideration given to starting Clenil Modulite 100mcg BD
• Follow-Up arranged as below

Discharge planning - points to consider

Discharge Checklist Completed?
All the following must be completed prior to discharge

• Inhaler technique checked
• Asthma booklet given
• Watched asthma education video
• Completed 3 days prednisolone or remaining doses prescribed for home
• Salbutamol inhaler (x2) and spacer dispensed
• Wheeze plan given and explained
• Parents advised what to do in event of clinical deterioration
• Advised to attend GP within 48 hours discharge
• Chronic features and criteria for follow-up reviewed
• (Please document any follow-up requested)
• Maintaining oxygen Saturations >/= 94% air
• Tolerating 3hrly multi-dosing
• Discharge Medication prescribed

Chronic features / Interval symptoms

If any of the following features:

• 3 or more ED presentations with wheeze in 1 year
• 3 or more courses of steroids for wheeze in 1 year
• Answered yes to interval symptoms on wheeze proforma

AND not on a Preventer inhaler then prescribe Clenil modulite 100mcg BD

If already on a preventive inhaler review compliance and criteria for follow-up to assess need for hospital outpatient based follow up.

Criteria for Acute Medical Paediatric Follow Up

GP’s should be able to manage the majority of children with wheeze

Patients who have been started on a clenil inhaler should be advised to attend their G.P. in 6 weeks to assess response.

Children where there is diagnostic uncertainty or very young children (between the ages of 2 and 3) with concern about recurrent presentations then discuss Follow up planning with either the general paediatrician or senior paediatric registrar on tel: 84678.

Criteria for Respiratory Team Follow Up

Any child requiring intravenous therapy for wheeze.

Patients who have required intravenous therapy for wheeze should be monitored in hospital for at least 24 hours post the discontinuation of all intravenous therapy.

Any child where there is a concern that they have failed to respond to significant asthma treatment.

ALL RESPIRATORY REFERRALS SHOULD BE DISCUSSED WITH RESPIRATORY TEAM PRIOR TO PATIENT DISCHARGE FROM HOSPITAL.

Escalation to intravenous therapy for acute wheeze integrated care pathway (ICP) - for patients over 2 years old.