Acute severe asthma

Paediatric emergency management · Breathing · Respiratory

Assess severity by work of breathing, air entry, SpO₂ and conscious level. Give high-flow oxygen to keep SpO₂ ≥94%.

Bronchodilators & steroid

• Salbutamol: nebulised 2.5 mg (<5 yr) / 5 mg (≥5 yr), back-to-back or continuous in severe cases.
• Add nebulised ipratropium 250 mcg with the first doses.
• Oral prednisolone 1–2 mg/kg or IV hydrocortisone 4 mg/kg.

Escalation

• IV magnesium sulfate 25–50 mg/kg (max 2 g) over 20 min.
• Consider IV salbutamol load then infusion, or aminophylline – with cardiac and electrolyte monitoring.
• HFNC / NIV; intubate only if exhausted or deteriorating (high risk – experienced operator).