Acute exacerbation of asthma

Advice for professionals to be used with parents and carers

What is an acute exacerbation of asthma?

A worsening of your child’s asthma caused by exposure to one of their triggers. These vary between children but the most common ones are coughs and colds, cold weather, cigarette smoke, pet fur or feathers and pollen.

Asthma Action Plan

Keep this plan with you and take it every time you see the doctor or nurse at your GP surgery (or Hospital). This plan is for patients with asthma – your GP/doctor (or nurse) will fill it in and explain the different medicines to control your asthma. It will also show you how to recognise when the asthma or wheeze is getting worse and what to do about it. By taking steps early – acute attacks can usually be prevented.

Paediatric Pathway

Click here to view the acute asthma paediatric pathway.


When should you worry?

If your child is:

  • Too breathless to talk / eat or drink
  • Has blue lips
  • Having symptoms of cough/wheeze or breathlessness which are getting worse despite 10 puffs blue (salbutamol) inhaler every 4 hours
  • Confused and drowsy
You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

Give the blue reliever (salbutamol) inhaler through a spacer device - 1 puff at a time every 60 seconds up to a maximum of 10 puffs. Repeat every 10 minutes until the ambulance arrives.

Keep child in upright position and reassure them

If your child is:

  • Wheezing and breathless and blue (salbutamol) reliever inhaler 2-4 puffs is not lasting 4 hours
  • Having a cough or wheeze/tight chest during the day and night
  • Too breathless to run / play / do normal activities
You need to contact your GP Surgery today

Immediately contact your GP or NHS 111 and make an appointment for your child to be seen that day face to face

Increase blue (salbutamol) reliever inhaler 6-10 puffs every 4 hours

If your child starts to cough, wheeze or has a tight chest but can continue day to day activities; if this continues for more than 5 days contact your GP

Self care

Give 2-4 puffs blue (salbutamol) reliever inhaler every 4 hours until symptoms improve

This guidance has been reviewed and adapted by healthcare professionals across the Black Country Integrated Care System.

Choose appropriate sized spacer with mask or mouthpiece if child is over 3 years old.


"Photo provided by IPCRG"

  1. Shake the inhaler well and remove cap
  2. Fit the inhaler into the opening at the end of the spacer
  3. Place mask over the child’s face or mouthpiece in their mouth ensuring a good seal
  4. Press the inhaler once and allow the child to take slow breaths between each puff 
  5. Remove the inhaler and shake between every puff. Wait 1 minute between puffs

Repeat steps 1 – 5 for subsequent puffs

Plastic spacers should be washed regularly as per manufacturer’s guidelines

For videos on using your child’s inhaler and spacer correctly see using your inhaler

Over the next few days, your child will need to be regularly given a blue (salbutamol) reliever inhaler. Your child can have 2-4 puffs every 4 hours, as needed for the next few days after which your child should be back to normal and you should be able to stop the blue inhaler. 

In the event that your child has been started on steroid tablets, then please complete the course given.  

If your child becomes increasingly breathless despite having 2-4 puffs every 4 hours, you should follow the instructions outlined in the asthma action plan above. 

You should continue your child’s normal preventer treatment(s) during an acute exacerbation of asthma. 

  • Ensure your child always has access to their reliever (blue) inhaler and spacer
  • Use a reliever enhaler as required and follow your personalised asthma action plan
  • Remember to leave a spare reliever inhaler (with/without spacer) at school for your child and ensure that it is kept in date
  • Remember to take all inhalers and asthma medicines with you or your child on any trips away from home
  • Always use the correct inhaler device as prescribed for you or your child
  • Remember a spacer is the best way to deliver reliever treatment in an emergency
  • Remember to keep any follow up appointments and attend their annual asthma review at their general practice
  • If your child has been discharged from hospital following an exacerbation, you should arrange for them to be seen in the next 48 hours by the GP Team/Practice nurse
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