SJH Emergency Medicine
Paediatric wheeze / asthma
Warning
This guideline describes the processes used in the assessment and management of acute wheeze in children. However, as with all the pages in this handbook, it does not replace clinical expertise and knowledge. If you are worried about a patient consider discussing with the EPIC and NIC to move to a suitable monitoring area, and getting additional expertise in managing the child.
If a patient is well enough for discharge, they should be able to manage their breathing on a maximum of 4 puffs of salbutamol via their inhaler, every 4 hours.
You should advise the patient and parent:
- to use the salbutamol inhaler 4 puffs every 4 hours on the day of discharge
- they can use the salbutamol inhaler as needed 4 puffs, 4 times a day for up to 4 days
- this is not a course of treatment, and can be reduced or stopped as needed
- the child can return to normal activities as soon as they feel better
- if the child has asthma, they should contact their GP / community services to get a review within 2 days
- if the child does not have asthma (i.e. their diagnosis was viral wheeze) they will only get a community review if they request it
- that if they need further medical review, to bring their inhaler and spacer with them
Discharge the patient with the paediatric PIL on going home with salbutamol
Do emphasise on the PIL on the course of management if the child is struggling with their breathing (i.e. 10 puffs of salbutamol, etc.) and what to do if this does not improve the situation
From June 2025, there is a separate protocol in NHS Lothian for children over 12 years old that are on AIR/MART therapy.
This will only impact a small group of patients we treat in the ED with paediatric wheeze / asthma. In children the changes will only affect children over the age of 12 as there are no suitable inhalers for smaller patients.
AIR/MART therapy is the use of single combined inhalers (i.e. has a beta agonist and a steroid in the same inhaler) for the management of asthma. There is a move both in adults and children away from separate reliever and preventer inhalers and towards use of a single inhaler. For more information on its implementation you can read and listen to the June 2025 presentation with audio from the CYP respiratory team.
Please see the separate AIR/MART management flowchart in these patients (below or in the linked document):
If these patients are discharged, they have a specific AIR/MART patient information leaflet.