How to treat asthma exacerbation

Use the treatment guide below and then enter patient details to generate a practical dose summary for salbutamol. After that, choose the response after the initial salbutamol doses.

Drug	Route	Dose	Duration	What to do if no improvement
Salbutamol	Inhaled	a) Inhaled via a spacer with a mask (Preferred) Children <6 years, 2-4 puffs per dose Children 6-12 years, 4-6 puffs per dose Children >12 years, 6-10 puffs per dose b) Nebulised <5 years, Nebulised salbutamol 2.5mg in 5mls of normal saline per dose >5 years, Nebulised salbutamol 5mg in 7.5 - 10mls of normal saline per dose Inhaler-spacer combination is more efficacious and cost-effective.	Given 3 doses 20 minutes apart. Then reassess. In case of improvement, then maintain 6 - 8 hourly for 3 - 5 days. Give 3 doses 20 minutes apart, then reassess. “Dose” refers to the number of puffs given during that episode. Life-threatening asthma, consider nebulisation while preparing for referral.	Check inhaler technique Check the dosage Ensure equipment is functional, especially nebulizers Ensure there are no triggers in the environment If these are reviewed and still no improvement, refer immediately.
Prednisolone	Oral	1-2mg/kg/day, max. 40mg/day	3-5 days
Oxygen therapy as needed, if SpO₂ is <90% on room air.

Drug

Route

Dose

Duration

What to do if no improvement

Salbutamol

Inhaled

a) Inhaled via a spacer with a mask (Preferred)

Children <6 years, 2-4 puffs per dose
Children 6-12 years, 4-6 puffs per dose
Children >12 years, 6-10 puffs per dose

b) Nebulised

<5 years, Nebulised salbutamol 2.5mg in 5mls of normal saline per dose
>5 years, Nebulised salbutamol 5mg in 7.5 - 10mls of normal saline per dose

Inhaler-spacer combination is more efficacious and cost-effective.

Given 3 doses 20 minutes apart.
Then reassess.

In case of improvement,
then maintain 6 - 8 hourly for 3 - 5 days.

Give 3 doses 20 minutes apart,
then reassess.

“Dose” refers to the number of puffs given during that episode.

Life-threatening asthma, consider nebulisation while preparing for referral.

Check inhaler technique
Check the dosage
Ensure equipment is functional, especially nebulizers
Ensure there are no triggers in the environment

If these are reviewed and still no improvement, refer immediately.

Prednisolone

Oral

1-2mg/kg/day, max. 40mg/day

3-5 days

Oxygen therapy as needed, if SpO₂ is <90% on room air.

Salbutamol

Route

Inhaled

Dose, spacer with mask (preferred)

Children <6 years, 2-4 puffs per dose
Children 6-12 years, 4-6 puffs per dose
Children >12 years, 6-10 puffs per dose

Dose, nebulised

<5 years, Nebulised salbutamol 2.5mg in 5mls of normal saline per dose
>5 years, Nebulised salbutamol 5mg in 7.5 - 10mls of normal saline per dose

Inhaler-spacer combination is more efficacious and cost-effective.

Duration

Give 3 doses 20 minutes apart, then reassess.

In case of improvement, maintain every 6 - 8 hourly for 3 - 5 days.

“Dose” refers to the number of puffs given during that episode. Life-threatening asthma, consider nebulisation while preparing for referral.

What to do if no improvement

Check inhaler technique
Check the dosage
Ensure equipment is functional, especially nebulizers
Ensure there are no triggers in the environment

If these are reviewed and still no improvement, refer immediately.

Prednisolone and oxygen

Prednisolone: 1-2mg/kg/day, max. 40mg/day for 3-5 days.

Oxygen: Give as needed if SpO₂ is <90% on room air.

Patient dose calculator

Enter the patient particulars below. A treatment summary with salbutamol dose will be generated first. Then choose the response after the initial salbutamol doses.

Age in years

Weight in kg

Preferred salbutamol method

SpO₂ (%)

Treatment summary

Fill in all required fields, then click Generate summary.

Salbutamol

Awaiting patient details

Current response after initial salbutamol doses

Prednisolone and next step

Awaiting patient details