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Asthma - Management
Children and adults not needing admission to hospital: How do I manage?

  • Prescribe a short course of oral prednisolone. The usual dose for someone not taking a regular corticosteroid is:
    • Child < 2 years: 10 mg once a day for 3 days
    • Child 2–5 years: 20 mg once a day for 3 days
    • Child 6–12 years: 30–40 mg once a day for 3 days
    • Adult or child > 12 years: 40–50 mg once a day for 5 days
  • Do not prescribe antibiotics routinely, unless symptoms and signs suggest a bacterial infection.
  • Advise the person (or parent of a child) to use their short-acting beta2-agonist via a large-volume spacer.
    • For an adult, give 4 puffs initially, followed by 2 puffs every 2 minutes according to response, up to 10 puffs.
    • For a child, give 2 puffs every 2 minutes according to response, up to 10 puffs.
    • Each puff should be given one at a time and inhaled with five tidal breaths. Repeat every 10–20 minutes according to clinical response.
  • After the short-acting beta2-agonist has been given (up to 10 puffs), advise the person (or parent of a child):
    • To return to using their short-acting beta2-agonist as-required, up to four times a day (not exceeding 4-hourly use).
    • To monitor their peak expiratory flow rate (PEFR) and symptoms. If symptoms worsen, or PEFR decreases after starting treatment, they should seek further medical advice.
  • Follow up a person (ideally) within 24 hours, or sooner if they deteriorate, and within 1 week after an exacerbation.

In depth

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