Patient handout

Pediatric asthma (chronic stepwise + acute exacerbation)

PRODUCTION

1. Your condition

This handout is for pediatric asthma (chronic stepwise + acute exacerbation). Your care team identified this based on: recurrent wheeze, cough, dyspnea in a child (gina 2026).

Other reasons your team may use this plan: exercise-induced wheeze / cough (gina 2026); severe acute exacerbation in child (accessory muscles, retractions, spo2 <92%, silent chest) (bts/sign 2024); saba over-use (>1 canister/3 mo) — review needed (gina 2026).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
budesonide-formoterol	100/6 µg (low-strength pediatric)	inhaled	1 puff PRN for symptoms	GINA 2026 anti-inflammatory reliever in 6-11 yr; reduces severe exacerbations vs SABA-only
albuterol	2 puffs MDI with spacer (or 0.15 mg/kg neb, min 2.5 mg, max 5 mg)	inhaled	PRN	Alternative reliever where ICS-formoterol PRN not available

Plan: GINA 2026 pediatric Track 1 (6-11 yr) — ICS-formoterol-based stepwise

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Doing well — no symptoms, PEF 80-100% personal best (≥6 yr)

If you have:

No cough, wheeze, chest tightness, or shortness of breath
Can play, run, sleep, attend school normally
No night waking from asthma
peak flow ≥80% personal best (if monitoring)

Do this:

Take controller as prescribed every day with spacer (do not skip)
Use reliever (controller inhaler-formoterol or rescue inhaler) only if needed before exercise or for symptoms
Continue trigger avoidance (no smoking around child)
Keep follow-up appointments and refill controller before it runs out

YELLOW — Caution — early warning, PEF 50-79% personal best OR symptoms increasing

If you have:

Cough, wheeze, chest tightness, or breathlessness
Waking at night with asthma
Reliever needed more than usual (more than every 4 h)
peak flow 50-79% personal best
Cold or viral URI starting

Do this:

Give reliever now (rescue inhaler 4-8 puffs MDI with spacer OR controller inhaler-formoterol 1-2 puffs PRN)
Repeat reliever every 20 minutes for the first hour if needed
If on MART: continue maintenance + use additional puffs as reliever
If not improving in 24-48 h or worsening: start prednisolone 1-2 mg/kg/day (max 60 mg) PO × 3-5 days OR dexamethasone 0.6 mg/kg × 1-2 doses (per pre-prescribed action plan)
Contact pediatrician within 24 h

Call your provider if:

Symptoms not improving after first hour of reliever
Any decline in peak flow below 50% best
Need to use reliever more often than every 4 h
Child cannot speak in full sentences / drinking less

RED — Medical alert — PEF <50% personal best OR severe symptoms

If you have:

Very short of breath, cannot speak in full sentences / phrases / words
Reliever not helping or wearing off in <2 h
peak flow <50% personal best
Lips, tongue, or fingertips blue
Confusion, drowsiness, or extreme agitation
Sucking-in around the ribs or neck (severe retractions)

Do this:

Use reliever right now: rescue inhaler 6-8 puffs MDI with spacer OR controller inhaler-formoterol 4-6 puffs; repeat every 20 minutes while seeking help
Give prednisolone 1-2 mg/kg PO now if available
Call 911 / emergency services immediately
Sit child upright; do not lie flat
Stay with the child — go to ED now, do not wait

Call your provider if:

Any red zone symptom — go to ED now, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

oxygen level (SpO₂) <92% on room air in a child with acute asthma (BTS/SIGN 2024)
peak flow <50% personal best after first-hour rescue inhaler + ipratropium + systemic steroid (≥6 yr) (GINA 2026)
Silent chest, drowsiness, agitation, exhaustion, or cyanosis in a child (BTS/SIGN 2024)(life-threatening)
PaCO2 rising or normalising in tachypnoeic severe pediatric asthma (PaCO2 should be LOW from hyperventilation) (BTS/SIGN 2024)(life-threatening)
Sudden onset wheeze in toddler, asymmetric breath sounds, hyperinflation on CXR (AAP)
PRAM/PASS severity → disposition (LR-style mapping; PRAM validated 2-17 yr, post-bronchodilator PRAM r=0.5 vs admission, PMID 18346499): PRAM 0-3 (PASS 0-2) MILD → discharge if sustained ≥1 h after last neb + technique verified + action plan; PRAM 4-7 (PASS 3-4) MODERATE → rescue inhaler q20min ×3 + ipratropium ED + oral steroid within 1 h, reassess at 1 h; PRAM ≥8 (PASS 5-6) SEVERE → continuous rescue inhaler + IV magnesium + admit, PICU if life-threatening features

5. Follow-up

Written pediatric asthma action plan, school plan, vaccinations (flu, pneumococcal, COVID), tobacco-smoke counselling, allergen control, growth monitoring, primary-care follow-up within 1 week of any ED/admission (GINA 2026; AAP)

6. Sources

Guideline: GINA 2026 Strategy Report (children ≤5 yr + 6-11 yr — distinct tracks; 4 new acute-asthma flowcharts) + NAEPP 2020 Focused Update (Cloutier JACI 2020;146:1217-1270) + AAP