asthma/wheeze management plan - enhertsccg.nhs.uk · asthma/wheeze management plan • this is your...
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Asthma/wheeze management plan
• This is your child’s discharge plan and treatment until their next review.
• Make an appointment with a GP or asthma nurse within 48hrs of discharge
• Symptoms of asthma include: Cough, wheeze, shortness of breath, chest tightness that may cause
difficulty in speaking or feeding. Not everyone with asthma will wheeze
• Please note how much treatment your child is requiring and how this helps
• When asthma is fully controlled your child should be symptom free and not require any reliever
inhaler (salbutamol.)
• Preventer medication should be used even when well
Out of hours call 111
Treatment
Medication When to use Name and strength
of medication
No. of puffs/dose Times per day
Reliever inhaler
usually Salbutamol
and blue
Use when your child is
coughing or wheezing or
their chest feels tight.
Preventer inhaler
Often brown,
orange or purple
Your child should use
their ( ) inhaler
every day
even when well
Prednisolone
(steroids)
Short course when
unwell, usually 3-5 days
Preventer tablet or
granules. Use
every day
Use every day
Other treatments:
Remember • Your child should use their Preventer inhaler ( ) every morning and evening and only stop
if their doctor or asthma nurse tells them to.
• Salbutamol is a reliever. When you child is well they will not need to use this at all
• Keep a salbutamol inhaler with you at all times.
• Start salbutamol as soon as your child gets symptoms and continue until symptoms have resolved.
Using salbutamol • Give 2 puffs. I puff at a time, wait for 2 minutes and assess the response, repeat if necessary continuing
up to 10 puffs.
• If your child does not respond to 10 puffs call 999 & repeat
• If your child needs to use their blue inhaler more often than every 4 hours you should take them to see
their doctor or use the out of hours services. (Call 111)
• If your child repeatedly needs doses of 6-10 puffs every 4 hours you should take them to see their doctor
or use the out of hours services. (Call 111) they are likely to need a course of steroids
Name of Patient Date of Birth NHS Number
GP surgery Telephone Next appointment
Children’s Assessment unit/ward telephone
Open access Y/N Until date
Some areas may instruct you to take your child to the Children’s Emergency
Department. Make sure you know what to do in your area
For more information about asthma http://www.asthma.org.uk T 0800 1216244 Smoking, even outside can affect your child’s health & asthma. Ask at your
surgery for help to quit. For more information www.smokefree.nhs.uk
Life
threatening
If your child is: • Drowsy • Has a severe wheeze • Is unable to speak in sentences • Is unable to respond
Ring 999 You need immediate help Give 2 puffs (1 at a time) every 2 minutes of
salbutamol via a spacer until the ambulance arrives
Severe
If your child is: • Frightened • Breathless with a heaving chest • Unable to speak in sentences/take fluids and is
getting tired
Ring 999 You need immediate help Give 2 puffs (1 at a time) every 2 minutes of
salbutamol via a spacer until the ambulance arrives
Moderate
If your child is: • Wheezing and breathless and not responding
to usual reliever treatment Monitor your child closely and look for signs to see if they are getting worse
Contact your GP to make an appointment for your child to be seen immediately. Out of hours call 111 Continue to give salbutamol as described earlier
Mild
If your child is: • Requiring their reliever regularly throughout the
day/night for cough or wheeze but is not
working hard with their breathing and is able to continue day to day activities
Arrange an appointment to see your GP as soon a
possible/preferably the same day or call 111 if it is out of hours Continue to give salbutamol as described earlier and watch them closely
1. Remove the cap.
2. Attach the mask to the spacer
mouthpiece.
3. Shake the inhaler and insert into back of
spacer.
4. Tip the spacer to an angle of 45° or
more to allow the valve to remain open.
5. Place the mask over the mouth and
nose of the child to ensure there is a
good seal.
6. Press the inhaler canister and keep the
mask on the child’s face for 5 breaths.
7. Remove the mask from the child’s face.
8. For a further dose wait 30 seconds and
repeat steps 3 to 7.
How to use an
MDI with a small
volume spacer
and mask –
(spacer may be
yellow, orange or
blue.)
1. Remove the cap from the inhaler. Shake
the inhaler and insert into the back of the
spacer.
2. Place the mask of the spacer over the
mouth and nose of the child and ensure
there is a good seal.
3. Keeping the spacer level press the
inhaler canister.
4. Encourage the child to breathe in and
out slowly and gently for 5 breaths, (if
you hear a whistling sound they are
breathing in to quickly).
5. Remove the mask from the child’s face.
6. If taking another dose, wait 30 seconds
and repeat steps 1-4. Replace
mouthpiece cover after use.
1. Remove caps from the inhaler and
spacer. Shake the inhaler and insert into
the back of the spacer.
2. Breathe out gently as far as is
comfortable. Put the mouthpiece of the
spacer into your mouth and seal your
lips around it.
3. Press the canister once to release a
dose of medicine. Breathe in slowly and
steadily (if you hear a whistling sound
you are breathing in too quickly).
4. Remove spacer from your mouth and
hold your breath for 10 seconds, or as
long as is possible, then breathe out
slowly.
5. If taking another dose, wait for 30
seconds and repeat steps 1-4. Replace
the mouthpiece covers after use.
How to use an
MDI with a small
volume spacer
How to use an
MDI with a large
volume spacer
and mask for
infant/small
child
Get help day or night. Do not worry about making a fuss
Medications reviewed by
Name: Signature:: Date
Copy of this plan sent to GP
Name: Signature:: Date
Information/education received by:
Name: Signature:: Date
Inhaler technique checked by
Name: Signature:: Date
Not all types of inhaler are shown here. Ask the doctor or nurse if you are unsure how to use the inhalers you have been given.
The type of inhaler and spacer with or without a mask you are given will depend on your child. For more information see http://www.asthma.org.uk/Sites/healthcare-professionals/pages/inhaler-demos
Management of Acute Exacerbation of Asthma / Wheeze
Primary Care Clinical Assessment Tool for Children Under 2 Years
History
• Breathless/wheeze/cough
• Viral or allergic trigger
• Previous episodes or interval symptoms
• FH or personal history asthma, eczema or atopy
• Current/Previous treatment and response
Consider other diagnosis • Pneumonia
• Bronchiolitis in under 1yr old
• Croup
• Foreign body
No – treat as below
It may not be asthma. Seek expert help Yes
Treat according to most severe feature
Moderate
• Able to feed or talk
• Moderate use of accessory
muscles
• Audible wheeze
• Sats>92% in air
<1 year
• RR<40/min HR 120-170/min
1-2 yrs
• R<35/min HR 80-110/min
• Give salbutamol 2-10 puffs via
spacer+facemask (one puff at a
time.)
• Increase by 2 puffs every 2
minutes up to 10 puffs according
to response
• Assess response and repeat if
necessary
• Give stat dose soluble
prednisolone 10mg
• Call 999
• Give high flow oxygen via fitted
mask aim for Sats 94-98%
• Give nebulised Salbutamol 2.5mg
(using 6L-8L oxygen)
• Reassess and repeat at 20-30
minute intervals or as necessary
• Give stat dose soluble
Prednisolone 10mg
• Consider nebulised Ipratropium
Bromide 250mcg (using 6L-8L
oxygen). Repeat every 20-30
minutes
• Commence resuscitation
• Call 999
• Give high flow Oxygen via fitted
mask
• Give back to back nebulised
Salbutamol 2.5mg (using 6L-8L
oxygen)
• Give stat dose soluble
Prednisolone 10mg
• Give nebulised Ipratropium
Bromide 250mcg (using 6L-8L
oxygen). Repeat every 20-30
minutes
Ensure a health professional stays with child
Contact duty paediatric registrar or consultant to arrange admission
Severe
• Previous attack within last 2 weeks
• Too breathless to feed or talk
• Marked use of accessory muscles
and wheeze
• Sats< 92 % in air
<1 yr:
• RR >40/min HR>170/min
1- 2yrs:
• RR >35/min HR >110/min
Life Threatening
• Sats <92% in air plus any of the
following:
• Silent chest
• Poor respiratory effort
• Exhausted and unresponsive
• Coma/agitation
• Cyanosis
• Bradycardia
• Apnoea
• Respiratory arrest
Examination
• Feeding and speech
• Respiratory rate
• Chest wall expansion and movement
• Use of accessory muscles
• Auscultation of chest – reduced air entry,
wheeze, prolonged expiration
• Oxygen Saturation (Sats)
Good response
• Reassess
within 1 hour
• Subtle or no
use of
accessory
muscles
• Minimum
wheeze
• Sats >92% in
air
Assessment
Poor
Response
Reconsider
diagnosis or
severe & life
threatening
episode
Ambulance transfer pathway
Continue to administer oxygen driven nebulised salbutamol if symptoms are
severe whilst transferring the child to the emergency department
Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler
• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask
• Complete a 3 day course of Prednisolone 10mg or 2mg/kg/dose
• Give acute asthma management plan
• Check inhaler technique and regular medication
• Review overall asthma control and consider need to step up medication
Arrange a review at GP practice within 48 hours and give advice on re-accessing medical care if condition worsens e.g.
OOH service (or open access to Children’s Assessment unit if an option.)
Full Respiratory assessment in 7-14 days in primary care
THINK TTT –
consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment
Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and
thanks to The Suffolk Respiratory Pathway Group
July 2013
Discharge from hospital and GP
Ensure a health professional stays with child
Contact duty paediatric registrar or consultant to arrange admission
Management of Acute Exacerbation of Asthma / Wheeze
Primary Care Clinical Assessment Tool for Children Over 2 Years
History
• Breathless/wheeze/cough/chest tightness
• Viral or allergic trigger
• Previous episodes or interval symptoms
• Family or personal history asthma, eczema
or atopy
• Current/Previous treatment and responses
Consider other diagnosis
• Pneumonia
• Bronchiolitis in under 1yr old
• Croup
• Foreign body
No – treat as below
It may not be asthma. Seek expert help Yes
Treat according to most severe feature
Moderate Exacerbation
• Able to talk
• Moderate respiratory
distress/wheeze
• Sats ≥92%
• PEF >50% predicted or best (>5yrs)
2-5 yrs:
• RR ≤40/min HR ≤ 140/min
5-12yrs:
• RR ≤30/min HR ≤ 125/min
12-18yrs:
• RR <25/min HR ≤ 110/mn
• Give Salbutamol 2-10 puffs via
spacer+facemask (one puff at a
time.)
• Increase by 2 puffs every 2
minutes up to 10 puffs according
to response
• Assess response and repeat if
necessary
• Give stat dose soluble
Prednisolone 20mg
• 2-5yrs and 30-40 mg > 5yrs or
2mg/Kg dose (maximum 40mg)
• Call 999
• Give high flow oxygen via fitted
face mask aim for Sats 94-98%
• Give nebulised Salbutamol (using
6L-8L oxygen):<5yrs 2.5mg and
• > 5yrs 5mg
• Reassess and Repeat at 20-
30min intervals or as necessary
• Give stat dose soluble
Prednisolone 20mg 2-5yrs and
30-40 mg > 5yrs or 2mg/Kg dose
(maximum 40mg)
• Consider nebulised Ipratropium
Bromide (using 6L oxygen):
<12yrs 250mcg;12-18yrs 500mcg
repeated every 20-30 minutes
• Commence resuscitation - ABC
• Call 999
• Give high flow oxygen via fitted
facemask
• Give back to back nebulised
Salbutamol (using 6L- 8L oxygen):
<5yrs 2.5mg; >5yrs 5mg
• Give stat dose soluble
Prednisolone 20mg 2-5yrs and
30-40 mg > 5yrs or 2mg/Kg dose
(maximum 40mg)
• Give nebulised Ipratropium
Bromide (using 6L oxygen):
<12yrs 250mcg;
• 12-18yrs 500mcg repeated every
20-30 mins
Severe
• Previous attack within last 2 weeks
• Too breathless to talk or complete
sentence
• Marked respiratory distress/wheeze
• Sats <92%
• PEF 33- 50% predicted or best
2-5yrs
• RR>40/min HR > 140/min
5-12yrs
• RR>30/min HR > 125/min
12-18yrs
• RR≥25/min HR >110/min
Life Threatening
• Sats <92% plus any of the
following:
• Silent chest
• Poor respiratory effort
• Exhausted and unresponsive
• Confusion/coma/agitation
• Cyanosis
• Bradycardia
• Respiratory arrest
• PEF not recordable or <33%
predicted or best
Examination
• Speech
• Respiratory rate
• Chest wall expansion and movement
• Use of accessory muscles
• Auscultation of chest – reduced air entry, wheeze, prolonged
expiration
• Oxygen Saturation (Sats)
• Peak flow measurement (>5yrs but often unreliable in younger age)
Good response
Reassess within
1 hour
• Subtle or no use
of accessory
muscles
• Minimum wheeze
• Sats >92% in air
• Rising PEF in
>5 yrs
Assessment
Poor
Response
Reconsider
diagnosis or
severe & life
threatening
episode
Ambulance transfer pathway
Continue to administer oxygen driven nebulised salbutamol if symptoms are
severe whilst transferring the child to the emergency department
Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler
• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask
• Complete a 3 day course of Prednisolone; child < 5 yrs 20mg; 5-12 yrs 30-40mg for 3 days; 12-18 yrs 40mg for 3- 5
days(or 2mg/kg dose up to 40mg )
• Give Acute Asthma Management Plan
• Check inhaler technique and regular medication
• Review overall asthma control and consider need to step up medication
• Arrange a review at GP practice within 48 hours and give advice on re-accessing medical care if condition worsens
e.g. OOH service (or open access to Children’s Assessment Unit if an option.)
Full Respiratory assessment in 7-14 days in primary care
THINK TTT –
consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment
Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and
thanks to The Suffolk Respiratory Pathway Group
Discharge from hospital and GP
Respiratory Rate at Rest:
<2-5yrs 25-30 breaths/min
5-12yrs 20-25 breaths/min
>12yrs 15-20 breaths/min
Heart Rate
<2-5yrs 95-140 bpm
5-12yrs 80-120 bpm
>12yrs 60-100 bpm
Height (m) Height (ft) Predicted EU PEFR (L/min)
0.85 2’9” 87
0.90 2’11” 95
0.95 3’1” 104
1.00 3’3” 115
1.05 3’5” 127
1.10 3’7” 141
1.15 3’9” 157
1.20 3’11” 174
1.25 4’1” 192
1.30 4’3” 212
1.35 4’5” 233
1.40 4’7” 254
1.45 4’9” 276
1.50 4’11” 299
1.55 5’1” 323
1.60 5’3” 346
1.65 5’5” 370
1.70 5’7” 393
Table 2: Predicted Peak flow: for use with EU/EN13826 scale PEF
metres only
Table 1: Normal Paediatric Values
Management of Acute Exacerbation of Asthma / Wheeze
Secondary Care Clinical Assessment Tool for Children Under 2 Years
History
• Breathless/wheeze/cough
• Viral or allergic trigger
• Previous episodes or interval symptoms
• FH or personal history asthma, eczema or
atopy
• Current/Previous treatment and response
Consider other diagnosis
• Pneumonia
• Bronchiolitis in under 1yr old
• Croup
• Foreign body
No – treat as below
It may not be asthma. Seek expert help Yes
Treat according to most severe feature
Moderate Exacerbation
• Able to feed or talk
• Moderate use of accessory
muscles
• Audible wheeze
• Sats >92% in air
< 1 yr:
• RR ≤40/min HR 120-170/min
1-2yrs:
• RR ≤35/min HR 80-110/min
• Give Salbutamol 2-10 puffs
via spacer+facemask (one
puff at a time.
• Increase by 2 puffs every
2 minutes up to 10 puffs
according to response
• Assess response and repeat
if necessary
• Give stat dose soluble
Prednisolone 10mg
• Give high flow Oxygen via fitted
mask aim for sats 94-98%
• Give nebulised Salbutamol 2.5mg
(using 6L-8L oxygen)
• Reassess and Repeat at 20-30
minute intervals or as necessary
• Give stat dose soluble Prednisolone
10mg
• Repeat dose if patient vomits, or
consider IV Hydrocortisone 4mg/Kg
• If Poor response Ipatropium
Bromide 250 micrograms via
oxygen driven nebuliser repeated
every 20-30minutes
• Poor response see life-threatening
• Discuss with senior clinician or
Paediatrician or PICU team
• Commence resuscitation -
ABC
• Give high flow Oxygen via
mask
PAEDIATRIC CARDIAC
ARREST CALL
• Give back to back nebulised
Salbutamol 2.5mg (using 6L-
8L oxygen)
• Give stat dose soluble
Prednisolone 10mg
• Repeat dose if patient vomits,
or consider IV Hydrocortisone
4mg/Kg
• Give nebulised Ipratropium
Bromide 250mcg (using 6L-
8L oxygen). Repeat every 20-
30 minutes
POOR RESPONSE
• Consider IV Salbutamol and
Magnesium
• Consider Chest X-Ray
• Arrange PICU/ITU admission
Severe
• Previous attack within last 2 weeks
• Too breathless to feed or talk
• Marked use of accessory muscles
and wheeze
• Sats< 92 % in air
• <1 yr:
• RR >40/min HR>170/min
• 1- 2yrs:
• RR >35/min HR >110/min
Life Threatening
• Sats <92% in air plus any of the
following:
• Silent chest
• Poor respiratory effort
• Exhausted and unresponsive
• Coma/agitation
• Cyanosis
• Bradycardia
• Apnoea
• Respiratory arrest
Examination
• Feeding and speech
• Respiratory rate
• Chest wall expansion and movement
• Use of accessory muscles
• Auscultation of chest – reduced air entry,
wheeze, prolonged expiration
• Oxygen Saturation (Sats)
Good response
Reassess within 1 hour
• Subtle or no use of accessory
muscles
• Minimum wheeze
• Sats >92% in air
Assessment
Poor Response
Reconsider diagnosis: Severe or
Life Threatening episode
Admit/further
observation on
Children’s
Assessment unit for
all cases if severe
symptoms after
initial treatment
Good
response
Continue
salbutamol
1-4 hourly
Re-Assess
regularly
Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler
• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask
• Complete a 3 day course of Prednisolone10 mg or 2mg/kg/dose
• Give Acute Asthma Management Plan
• Check inhaler technique and regular medication
• Review overall asthma control and consider need to step up medication
• Arrange review at GP practise 48hrs
• Open access to Children’s Assessment Unit for 48hours
• Full respiratory review at GP practise in 7-14 days
• Arrange FU in clinic with Asthma Consultant/nurse
THINK TTT –
consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment
Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and
thanks to The Suffolk Respiratory Pathway Group.
July 2013
Discharge from hospital and GP
Management of Acute Exacerbation of Asthma / Wheeze
Secondary Care Clinical Assessment Tool for Children Over 2 Years
History
• Breathless/wheeze/cough/chest tightness
• Viral or allergic trigger
• Previous episodes or interval symptoms
• Family or personal history asthma, eczema
or atopy
• Current/Previous treatment and responses
Consider other diagnosis
• Pneumonia
• Croup
• Foreign body
• Hyperventilation/panic attack
No – treat as below
It may not be asthma. Seek expert help Yes
Treat according to most severe feature
Moderate Exacerbation
• Able to talk
• Moderate respiratory
distress/wheeze
• Oxygen Sats ≥92%
• PEF >50% predicted or best (>5yrs)
2-5 yrs:
• RR ≤40/min HR ≤ 140/min
5-12yrs:
• RR ≤30/min HR ≤ 125/min
12-18yrs:
• RR <25/min HR ≤ 110/mn
• Give Salbutamol 2-10 puffs via
spacer+facemask (given one at a
time)
• Increase by 2 puffs every 2
minutes up to 10 puffs according
to response
• Assess response and repeat if
necessary
• Give stat dose soluble
Prednisolone 20mg
• 2-5yrs and 30-40 mg > 5yrs or
2mg/Kg dose (maximum 40mg)
• Give high flow oxygen via fitted face
mask aim for Sats 94-98%
• Give nebulised Salbutamol (using 6L
oxygen). <5yrs 2.5mg and > 5yrs 5mg
• Reassess and Repeat at 20-30min
intervals or as necessary
• Give stat dose soluble Prednisolone
20mg 2-5yrs and 30-40 mg > 5yrs or
2mg/Kg dose (maximum 40mg)
• Or IV Hydrocortisone 4mg/Kg
• If poor response nebulised Ipratropium
Bromide (using 6L oxygen): <12yrs
250mcg;12-18yrs 500mcg repeated
every 20-30 minutes
• Poor response see life-threatening
Discuss with senior clinician or
Paediatrician or PICU team
• Commence resuscitation - ABC
• Give high flow oxygen via a facemask
to achieve Sp0₂ 94-98%
PAEDIATRIC CARDIAC ARREST CALL
Give back to back nebulised Salbutamol
(using 6L-8L oxygen). <5yrs 2.5mg,
>5yrs 5mg
• Give oral prednisolone 20mg 2-5yrs
and 30-40 mg > 5yrs or 2mg/Kg dose
(maximum 40mg)
• Or Hydrocortisone 4mg/Kg
• Give nebulised Ipratropium Bromide
(using 6L-8L oxygen). <12yrs 250mcg
12-18yrs 500mcg repeated every 20-
30 minutes
POOR RESPONSE
Ensure consultant paediatrician present
IV Salbutamol 15mcg/Kg bolus over 10
minutes followed by continuous infusion
1-5mcg/Kg/min (dilute to 200mcg/ml)
IV Aminophylline 5mg/Kg loading dose
over 20 minutes followed by continuous
infusion 1 mg/Kg/hour
Bolus IV infusion of Magnesium
Sulphate 40mg/Kg (max 2g) over 20
mins
Consider CXR and blood gases
Arrange PICU/HDU admission
Severe
• Previous attack within last 2 weeks
• Too breathless to talk or complete
sentence
• Marked respiratory distress/wheeze
• Sats <92%
• PEF 33- 50% predicted or best
2-5yrs
• RR>40/min HR > 140/min
5-12yrs
• RR>30/min HR > 125/min
12-18yrs
• RR≥25/min HR >110/min
Life Threatening
• Oxygen sats <92% plus any of
the following:
• Silent chest
• Poor respiratory effort
• Exhausted and unresponsive
• Confusion/coma/agitation
• Cyanosis
• Bradycardia
• Respiratory arrest
• PEF not recordable or <33%
predicted or best
Examination
• Able to speak in sentences
• Respiratory rate
• Chest wall expansion and movement
• Use of accessory muscles
• Auscultation of chest – reduced air entry, wheeze, prolonged
expiration
• Oxygen Saturation
• Peak flow measurement (>5yrs but often unreliable in younger age)
Good response
Reassess within
1 hour
• Subtle or no use
of accessory
muscles
• Minimum wheeze
• Sats >92% in air
• Rising PEF in
>5 yrs
Assessment
Poor
Response
Reconsider
diagnosis:
Severe or
Life
Threatening
episode
Admit/further
observation on
Children’s
Assessment unit for
all cases if severe
symptoms after
initial treatment
Good
response
Continue
salbutamol 1-
4 hourly
Re-Assess
regularly
Patient must be stable have minimal recession with Sats >92% and manage 3-4 hourly between doses of inhaler
• Discharge on salbutamol 2-10 puffs up to 4 hourly via spacer + facemask
• Complete a 3 day course of Prednisolone; child < 5 yrs 20mg; 5-12 yrs 30-40mg for 3 days; 12-18 yrs 40mg for 3- 5
days(or 2mg/kg dose up to 40mg )
• Give acute asthma management plan
• Check inhaler technique and regular medication
• Review overall asthma control and consider need to step up medication
• Arrange a review at GP practice within 48 hrs
• Open access to Children’s Assessment Unit for 48hours
• Full respiratory review at GP practise in 7-14 days
• Arrange FU in clinic with Asthma Consultant/nurse
THINK TTT –
consider compliance with existing Therapy, Inhaler Technique and Triggers before stepping up treatment
Ref: The British Thoracic Society (BTS) and SIGN Guideline on the Management of Asthma (Revised Jan 2012) and
thanks to The Suffolk Respiratory Pathway Group
July 2013
Discharge from hospital and GP
Respiratory Rate at Rest:
<2-5yrs 25-30 breaths/min
5-12yrs 20-25 breaths/min
>12yrs 15-20 breaths/min
Heart Rate
<2-5yrs 95-140 bpm
5-12yrs 80-120 bpm
>12yrs 60-100 bpm
Systolic Blood Pressure
<2-5yrs 80-100 mmhg
5-12yrs 90-110 mmhg
>12yrs 100-120 mmhg
Height (m) Height (ft) Predicted EU PEFR (L/min)
0.85 2’9” 87
0.90 2’11” 95
0.95 3’1” 104
1.00 3’3” 115
1.05 3’5” 127
1.10 3’7” 141
1.15 3’9” 157
1.20 3’11” 174
1.25 4’1” 192
1.30 4’3” 212
1.35 4’5” 233
1.40 4’7” 254
1.45 4’9” 276
1.50 4’11” 299
1.55 5’1” 323
1.60 5’3” 346
1.65 5’5” 370
1.70 5’7” 393
Table 2: Predicted Peak flow: for use with EU/EN13826 scale PEF Table 1: Normal Paediatric Values
metres only