Asthma - Acute Paediatric - 4

Important: Accurate assessment of severity is crucial for appropriate management - ask for help if you are unsure   

History taking

Identify from parent or child:
- current medication
- past history
- known triggers/allergens/ drug allergies
- previous admissions (including intensive care)
- when did this episode start?
- precipitating cause? (including recent upper/ lower respiratory tract infection (URTI / LRTI))
- is it getting worse or better?
- what treatment has been used?
- how does this episode compare with previous episodes?    


In the acute situation most investigations are not particularly useful.
The exception is the Peak Expiratory Flow Rate (PEFR) - in litres/min

However most children under 8 cannot reliably perform PEFR/spirometry - inaccurately low results may cause unnecessary treatment.

Arterial blood gas samples should not generally be performed in children. They are painful and rarely add to the clinical assessment.    

Should I do a chest X-ray (CXR) ?

A CXR is unnecessary in most situations, unless
- focal signs are present
- response to treatment is poor
- pneumothorax is suspected.