Acute asthma exacerbation in children

Last reviewed: 25 Aug 2022
Last updated: 19 Aug 2021



History and exam

Key diagnostic factors

  • wheezing
  • shortness of breath
  • tachypnea
  • chest tightness
More key diagnostic factors

Other diagnostic factors

  • cough
  • exercise limitation
  • tachycardia
  • inability to speak or feed
  • intercostal, subcostal, or sternal retraction
  • accessory muscle use
  • pulsus paradoxus
  • sleep disturbance
  • bradycardia
  • cyanosis
  • exhaustion
  • decreased consciousness level
Other diagnostic factors

Risk factors

  • viral infection
  • uncontrolled asthma symptoms
  • high use of short-acting beta-2 agonists
  • inadequate use of inhaled corticosteroids
  • incorrect inhaler technique
  • low forced expiratory volume in 1 second (FEV₁)
  • high bronchodilator reversibility
  • inhaled allergens
  • exercise
  • poor adherence with regular asthma medication
  • history of asthma
  • history of other atopic disease
  • family history of atopic disease
  • history of hospitalization for asthma exacerbations
  • one or more severe exacerbations in the past 12 months
  • low socioeconomic status
  • environmental irritants
  • African-American ethnicity
  • vitamin D deficiency
  • obesity
  • younger age
  • low parental education
  • bacterial infection
  • emotion
  • nonsteroidal anti-inflammatory drug (NSAID) use
More risk factors

Diagnostic investigations

1st investigations to order

  • response to treatment with a short-acting beta-2 agonist
  • peak expiratory flow rate or FEV₁
  • oxygen saturation
More 1st investigations to order

Investigations to consider

  • arterial or venous blood gases
  • chest x-ray
More investigations to consider

Treatment algorithm


life-threatening exacerbation or impending respiratory failure

severe exacerbation

mild to moderate exacerbation



Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD

Respiratory and Sleep Physician

The Children's Hospital at Westmead

Clinical Associate Professor

Discipline of Paediatrics and Child Health

Sydney Medical School

University of Sydney


New South Wales



PDR declares that he has no competing interests.



Menzies School of Health Research

Charles Darwin University

Northern Territory

Respiratory and Sleep Physician

Queensland Children's Hospital

Queensland University of Technology




AC's institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC also received fees from UpToDate for writing topics on cough in children. AC is an author of references cited in this topic.

Peer reviewers

Lucille A. Lester, MD

Professor of Pediatrics

University of Chicago Comer Children's Hospital




LAL declares that she has no competing interests.

Caro Minasian, BSc (Hons), MB, BS, FCPCH, MD (Res)

Consultant in Paediatrics

Adolescent Medicine & Paediatric Respiratory Medicine

University College London Hospitals NHS Foundation Trust




CM declares that he has no competing interests.

  • Acute asthma exacerbation in children images
  • Differentials

    • Inhaled foreign body
    • Viral-induced infantile wheezing
    • Aspiration
    More Differentials
  • Guidelines

    • Global strategy for asthma management and prevention
    • Australian asthma handbook
    More Guidelines
  • Patient leaflets

    Asthma in children: what is it?

    Asthma in children: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer