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Publication Date



These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.

Objective of the Guideline

The objective of this guideline is to improve and standardize care of children seen in the Emergency Department (ED) and Urgent Care Centers (UCC) for an asthma exacerbation.

Target Users

ED/UCC physicians, General Pediatricians, Fellows, Resident Physicians, Pediatric Nurse Practitioners

Clinical Questions Answered by Guideline

1. For the pediatric patient who presents to the emergency department or urgent care center (ED/UCC) with an acute asthma exacerbation, is there a score that is reliable and valid to assess the severity of the exacerbation, and the patient’s response to treatment?

2. What oxygen saturation (SpO2) level should be maintained during an acute asthma exacerbation?

3. For the patient who presents to the ED/UCC with a mild to moderate asthma exacerbation, are metered-dose inhalers (MDI) comparable to nebulizer mask treatment for the provision of albuterol?

4. For the patient who presents to the ED/UCC with mild, moderate, or severe asthma symptoms what is the optimal dose (including maximum dose) of glucocorticosteroids to improve asthma symptoms, reduce admission to the hospital, and decrease length of stay in the ED/UCC?

5. Is oral dexamethasone more efficacious than prednisone/prednisolone for a pediatric asthma exacerbation?

6. For the patient who presents to the ED/UCC with an asthma exacerbation, is treatment with inhaled glucocorticosteroids (ICS) as efficacious as treatment with oral glucocorticosteroids (CS)?

7. For the patient who presents to the ED/UCC with a moderate/severe asthma exacerbation, should ipratropium bromide (IB) be considered as an adjunct to standard treatment with albuterol to reduce hospital admissions, adverse effects and improve pulmonary function?

8. For the patient who presents to the ED/UCC with a severe or non-resolving asthma exacerbation, should the patient be treated with intravenous (IV) magnesium sulfate?

9. For the patient who presents to the ED/UCC with an asthma exacerbation should noninvasive ventilation, either continuous positive airway pressure or non-invasive spontaneous timed positive airway pressure be used to reduce hospital admission, ED length of stay, or improve pulmonary function?

10. Should epinephrine 1:1000 IM be considered in a severe exacerbation/ impending respiratory failure?


Asthma; Emergency Department; Urgent Care



Asthma Care in the Emergency Department and Urgent Care Center

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Pediatrics Commons