Background
- According to the WHO, asthma is the most common chronic disease in children
- Clinically it manifests as recurrent episodes of wheezing, dyspnoea, chest tightness and cough
- Episodes are associated with variable airflow obstruction that is usually reversible
- Children < 12 months of age presenting with wheeze are likely to have bronchiolitis, which will not respond to bronchodilators. See bronchiolitis guideline
Inhaled corticosteroids (ICS) on discharge
Who to start ICS on discharge:
- Children who present with asthma
- Children with > 3 preschool wheeze episodes
What dose?
- >6 years: start dose Becotide 100 BD, ↑ to 200 BD if already taking ICS
- 2-6 years: Becotide 50 or 100, one puff twice daily
How long?
- In asthma, continue ICS long term. Review treatment with GP and/or Paediatrician at least once a year
- In preschool wheeze, prescribe ICS for 3 months and assess response, stop if no benefit. Even if benefit, many children can also stop ICS in Spring time if viral infections are a predominant trigger as many pre-schoolers stop wheezing with viruses as they get older
Discharge checklist
- Observe inhaler technique (video tutorial.)
- Appropriate prescription if indicated
- Give parent info. leaflet and discuss about when to return to the ED
- Arrange for GP review within 48 hours
- Discharge with an asthma action plan RCH version
Links / Resources References
- Print version above CUH CED guideline
- Print version CUH ward care guideline
- Asthma Parent Information Sheet
- Spacer Advice Sheet
- https://www.who.int/respiratory/asthma/en/