Going home from the Emergency Department with a salbutamol inhaler and spacer

Day of discharge from the Emergency Department (ED)

Once your doctor or nurse is happy that your child’s breathing is getting better and they can manage on 4 puffs of their blue (salbutamol) inhaler every 4 hours, they can go home.

You should continue to use the blue inhaler as required, up to 4 puffs every 4 hours on the day of discharge. You do not need to give the blue inhaler overnight unless you hear your child coughing/ wheezing or if your child tells you they need it.

You may, however, want to check on them through the night if they were discharged from the ED in the evening/ early hours of the morning.

Days after discharge

Although your child should be recovering from their wheezy episode, they may still have an occasional cough or a slight wheeze until they fully recover. You can continue to use between 2- 4 puffs of the blue inhaler, 4 times per day for up to 4 days if needed for shortness of breath and/or wheeze.

This is not a course of treatment and can be reduced or stopped depending on symptoms.

Your child can return to their normal activities (e.g. nursery/ school) when you feel they are well enough.

Your GP will receive information about your child’s ED attendance.

All children who have had an asthma attack should have a post-attack review to make sure your child has fully recovered, usually within 2 working days, with a member of the team at the GP surgery.

Your surgery may decide this should be with a GP, Advanced Nurse Practitioner, Practice Nurse or Pharmacist. You will need to arrange this. Children who do not have a formal asthma diagnosis, but have had a viral wheeze episode, will only have a review in the GP surgery if you specifically request this from your practice.

Inhaler technique and how to tell when your inhaler is empty

It is important to make sure your child is using their inhaler correctly and how to tell when the inhaler is finished, as it does not have a dose counter.

An inhaler that no longer ‘puffs’ will not have been providing any medication for some time.

You can watch these helpful videos that will provide more information.

• Using a pMDI inhaler with an AeroChamber Plus Flow-Vu® Spacer and Mask (for children aged 1–5 years old)
• Using a pMDI inhaler with an AeroChamber Plus Flow-Vu® Spacer with Mouthpiece (for children over 5 years old)

Advice on how to manage future wheezy episodes

No symptoms

Action: no blue inhaler required

Getting a cold or contact with a trigger

Action: take between 2- 4 puffs of the blue inhaler, 4 times a day, for 4 days. This is not a course and can be used less frequently or stopped depending on symptoms.

Coughing and wheezing

Your child is coughing and wheezing. They are breathing faster and making more effort with their breathing. They are finding it difficult to talk, eat and drink or lie down to sleep. You are worried about their breathing.

Action: take 10 puffs of the blue inhaler over 10 minutes. This is called an emergency dose. This should last for at least 4 hours.

All inhalers should be given through the spacer.

If you need to repeat the emergency dose within 24 hours at home, you need to get urgent medical advice, day or night.

If your child does not get better after the emergency dose, can only speak single words or cannot talk, is gasping for breath or has a colour change, they need urgent help – you must phone 999 for an ambulance.

While you are waiting for help to arrive, continue to give 1 puff of their blue inhaler each minute.

Remember: if you are worried about your child, get medical advice straight away.

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