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ROYAL FREE LONDON NHS FOUNDATION TRUST

PAEDIATRIC GUIDELINES

Paediatric Asthma/Wheeze Guideline

Author(s):

Richard Berg, Eli Safi, Neil Thompson

Contact author:

Shye-Wei Wong, Lynn Sinitsky

Other contributors:

Chloe Benn, Colette Dat, Benita Morrissey, UCLP Asthma Network

Previous authors:

Rahul Chodhari

Related guidelines or documents:

2016 BTS/SIGN Guideline for the management of asthma

NICE quality standard QS25

Approved by:

The Paediatric Guidelines Group on behalf of the Women, Children and Imaging Services Division

Issue no (Version):

November 2016 (version no. 1.0)

File name:

Paediatric Asthma_Wheeze Guideline

Key words: (up to 10)

Paediatric Asthma Wheeze

Supercedes:

Asthma guideline 06/09/2006

Significant change in practice:

Use of magnesium IV bolus prior to salbutamol bolus

Patients should receive a personalized asthma plan prior to discharge

Implementation plan:

Dissemination of the guideline via the intranet, guideline events and department meetings

Monitoring via clinical audit via the local audit programme

Service Line Lead

Paediatrics: Rahul Chodhari

Clinical Director for Paediatrics

Tim Wickham

Divisional Director of Nursing

Mai Buckley

For Review:

May 2017 or in response to practice developments

Contents

Introduction4

SECTION A: MANAGEMENT OF CHILD WITH ACUTE WHEEZE/ASTHMA5

Assessment of acute wheeze/asthma5

1.History5

2.Examination5

3.Assessing severity6

4.Investigations7

Ensuring the correct diagnosis8

Wheeze in the preschool child9

Young people and adolescents9

Difficult Asthma10

Acute wheeze flowchart for children 2-16 years11

The deteriorating child with wheeze/asthma12

Medications for acute wheeze/asthma13

SECTION B: MEDICATION13

Weaning bronchodilators15

Preventer therapy for children >5 years16

Preventer therapy for children 94% in air

>92% air