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Asthma in children
In childhood asthma the treatment is chosen by age and control: under 6 viral wheeze is separated from persistent asthma, from age 6 the GINA steps are used, and at every age the acute attack is treated with a SABA via a spacer and a systemic steroid.
Why it matters in the exam
The exam tests two things: treatment of the acute attack (SABA by inhaler and spacer every 20 minutes in the first hour, oral prednisolone, oxygen to a saturation target of 94%–98%, ipratropium in moderate-to-severe attacks and intravenous magnesium sulfate in severe attacks), and preventive treatment — when to start an ICS and what to add when control is lacking. Danger signs: a "silent" chest, drowsiness, inability to talk and a saturation below 92%.
An important GINA principle: a child is not left on a SABA alone for long; an ICS is combined even at the lowest step. From age 12 the preferred reliever is as-needed ICS-formoterol. In young children the diagnosis is clinical — the wheeze pattern, triggers and response to treatment — and spirometry is usually possible from age 5–6: an FEV1 rise of at least 12% after a bronchodilator supports the diagnosis.
A written home action plan, explaining when to step up treatment and when to go to the emergency department, is part of the care of every child with asthma.
Key points
- Attack: SABA by spacer every 20 minutes, prednisolone 1–2 mg/kg for 3–5 days.
- Severe attack: oxygen to a target of 94%–98%, ipratropium and intravenous magnesium sulfate.
- Prevention: daily low-dose ICS at any age when symptoms are frequent.
- From age 12: as-needed ICS-formoterol; not a SABA alone.
- Spirometry from age 5–6: an FEV1 rise of at least 12%.
Summary table
| Situation | Treatment | Exam note |
|---|---|---|
| Mild to moderate attack | SABA 4–10 puffs by spacer every 20 minutes in the first hour; prednisolone 1–2 mg/kg (up to 40 mg) for 3–5 days | A spacer is as effective as a nebuliser |
| Severe attack | Oxygen to a target of 94%–98%, SABA and ipratropium, prednisolone; intravenous magnesium sulfate 40–50 mg/kg (up to 2 g) | Silent chest, drowsiness, saturation below 92% = danger |
| Age 5 and under, prevention | Frequent or severe wheezing → daily low-dose ICS | Alternative: LTRA; if it fails — double the ICS dose and refer |
| Age 6–11, prevention | Daily low-dose ICS; at the next step low-dose ICS-LABA or medium-dose ICS | Check inhaler technique and adherence before stepping up |
| Age 12 and over | As-needed ICS-formoterol (and at higher steps also as maintenance) | Not a SABA alone |
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
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Sources
- Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention, 2024 — Children 5 years and younger; children 6–11 years; management of exacerbations
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Childhood Asthma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.