The video version of this podcast can be found here: ·      https://youtu.be/FkZmvfQVby8This channel may make reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido (also known as Juan Fernando Florido Santana), a GP in the UK. In this episode, I will go through the new NICE guideline on acute asthma, NG244, focusing on what is relevant in Primary Care only. Given how extensive the guidance is, in this episode I will just focus on the initial assessment of acute asthma in children. In the last two episodes I covered the initial assessment and treatment in adults and in the next two episodes, I will cover:·      Treatment of acute asthma in children·      And finally, lessons from asthma deaths and near-fatal asthma as well as reviewing the concept of difficult asthma Just like the NICE guideline on the management of chronic asthma, which was updated in November 2024, the NICE guideline on acute asthma is also a collaborative initiative developed by NICE, the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN). It replaces previous guidance, and you can find a link to it in the episode description.I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.   Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through  There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast:  ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The link to the new NICE guideline on acute asthma can be found here:·      https://www.nice.org.uk/guidance/ng244/chapter/Managing-acute-asthmaBased on recommendations on managing acute asthma in the BTS/SIGN British guideline on the management of asthma:·      https://rightdecisions.scot.nhs.uk/bts-nice-and-sign-asthma-pathway/managing-acute-asthma/ Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido.TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the new NICE guideline on acute asthma, or NG244, focusing on what is relevant in Primary Care only. Just like in chronic asthma, the NICE guideline on acute asthma is a joint effort by NICE, BTS and SIGN. A link to it is in the episode description.In this episode I will just focus on the initial assessment of acute asthma in children. In the last two episodes I covered the initial assessment and treatment in adults and in the next two episodes, I will cover the treatment of acute asthma in children and lessons from asthma deaths. So, stay tuned for those!Right, let’s jump into it.Acute asthma in children, particularly in those under five, can be challenging to assess.In this age group, intermittent wheezing attacks are often triggered by viral infections, and the response to asthma medications can be inconsistent. Children born prematurely or with low birth weight are at higher risk of recurrent wheezing episodes.We should also consider other potential diagnoses, which may include:Aspiration pneumonitis,Pneumonia,Bronchiolitis,Tracheomalacia,Or complications from underlying conditions, such as congenital anomalies or cystic fibrosis.This guideline is intended for children with acute wheeze related to underlying asthma.It should be used cautiously in children under two years of age who do not yet have a confirmed asthma diagnosis.It is not intended for children under one year unless directed by a respiratory paediatrician.Additionally, this guideline should not be used to treat acute bronchiolitis.Now let’s look at the different measurements and investigations that apply to children.And let’s start with the assessment of Oxygen Saturation and Pulse Oximetry.Accurate pulse oximetry using paediatric probes is essential in all children with acute wheezing. Paediatric pulse oximeters can involve the placement of a small probe on the finger, toe, or ear lobe of an older child but, in neonates and infants, probes may also be placed on other parts of the body such as the palms, feet, arms, and cheeks. From a general perspective, Intensive inpatient treatment should be considered if SpO2 <92% in room air persists after initial bronchodilator treatment.Next is PEF Measurements, which can be useful in Children, but they are only reliable in children who are familiar with the device.Also, When measuring PEF:We should Use the best of three measurements,And Express it as a percentage of the personal best, when known, or predicted if not known. A PEF <50% of predicted with poor improvement after initial bronchodilator therapy suggests the need for more aggressive hospital management.Next, Chest X-rays are not routinely indicated in children with acute asthma. However, we will consider a chest X-ray if we suspect:Subcutaneous emphysema,Persistent unilateral signs, which may indicate pneumothorax,Lobar collapse or consolidation,Or in cases of life-threatening asthma which is not responding to treatment.Now let’s move onto the Clinical Assessment. And for this, we will look at the different categories of acute asthma in children.And we will start with Moderate Acute Asthma, which is when the child:Is Able to talk in sentences,Has a SpO2 ≥92%,A PEF ≥50% of best or predicted,A Heart rate of: ≤140/min in children aged 1–5 years,≤125/min in children over 5 years,And a Respiratory rate of: ≤40/min in children aged 1–5 years,≤30/min in children over 5 years.The next category is Acute Severe Asthma, which is when the child:Is Too breathless to talk or feed,Has a SpO2 <92%,A PEF between 33 and 50% of best or predicted,A Heart rate of: >140/min in children aged 1–5 years,>125/min in children over 5 years,And a Respiratory rate of: > 40/min in children aged 1–5 years,> 30/min in children over 5 years.Then we have Life-Threatening Asthma, which is when any one of the following is found in a patient with severe asthma:Exhaustion,A SpO2 of <92%,Hypotension,A PEF of  <33% of best or predicted,Cyanosis,Silent chest,Poor respiratory effort, orConfusion.During the assessment, we should document the following:Pulse rate, bearing in mind that: Tachycardia generally indicates worsening asthma, whereasA fall in heart rate in life-threatening asthma is a preterminal event.Respiratory rate and degree of breathlessness: For example, if the child is too breathless to complete sentences or to feed.The Use of accessory muscles: Which is Best noted by palpating the neck muscles.The Wheezing intensity which may become biphasic or diminish with increased airway obstruction.And agitation and conscious leve,l always giving calm reassurance throughout the assessment.However Clinical signs can correlate poorly with the severity of airways obstruction and some children with acute severe asthma may not appear distressed.Therefore, in order not to miss these patients, Decisions about admission to hospital should be made after repeated assessment of the response to bronchodilator treatment.In other words, Frequent reassessment is essential, as clinical signs may not always correlate with the severity of airway obstruction.So that is it, a review of the initial assessment of acute asthma in children. We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.Thank you for listening and goodbye.

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