The child with asthma: monitoring an attack and the written action plan
- Safe practice
During an attack the nurse watches breathing before and after each dose; at home a written action plan tells the family what to do in each zone.
What it is
Asthma is the most common chronic disease of childhood. In an attack the nurse gives the prescribed quick-relief medicine with a spacer, gives oxygen if the child is in distress, and reassesses after each dose to decide whether the child improves or needs referral. Between attacks, nursing work is teaching: the difference between controller and reliever medicines, inhaler technique, triggers, peak flow in older children and the written asthma action plan, which also goes to the school.
What it requires
- A written action plan for every child, made with the health team.
- Correct inhaler technique with a spacer (see the inhaler page).
- Trigger control: tobacco smoke, dust, mould, pollen, animal dander, colds, cold weather.
- School staff hold a copy of the plan and know how to handle symptoms during exercise.
How it is applied (and why)
- Count respiratory rate, look for indrawing, listen for wheeze and measure SpO2 — this is the baseline for every decision.
- Sit the child up and keep the child calm with the caregiver close — sitting up allows full chest expansion.
- Give oxygen per protocol if there are signs of respiratory distress — AIEPI asks for oxygen during treatment cycles.
- Give the prescribed reliever with a spacer, one puff at a time — the spacer is how a child receives the dose.
- Reassess after each dose and record the response — improvement or no improvement decides the next step.
- If the child does not improve after the treatment cycles, refer or escalate now — the attack is not responding.
- Teach controller versus reliever, the inhaler technique and the triggers at home — daily controllers and trigger avoidance prevent symptoms.
- In children aged 5 or over, teach peak flow and the zones of the action plan — readings drop when the airways narrow.
- Give the family and school a copy of the plan and arrange follow-up — a plan only works if those around the child have it.
In nursing practice
- Children under 5 may not use a peak flow meter reliably; symptoms guide the plan.
- Drowsiness, confusion or decreased alertness during an attack are emergency signs, not signs of calm.
- Asthma does not stop a child from exercising when it is well controlled.
- Contact the health team when peak flow keeps falling or symptoms become more frequent despite following the plan.
Common mistakes
- Giving the reliever without measuring breathing before and after.
- Using the inhaler without a spacer in a young child.
- Stopping the controller when the child feels well.
- Sending the child home without a written plan, or without giving a copy to the school.
Test yourself
Think of the answer, then tap the question to see it.
What does the nurse check after each dose of reliever during an attack?
Respiratory rate, signs of respiratory distress, oxygen saturation and how the child looks and feels.
What does the red zone of an asthma action plan mean?
A medical alert: great difficulty breathing, reliever not helping, or peak flow below half of the child's best; get medical help.
What is the difference between controller and reliever medicines?
Controllers are taken every day to prevent symptoms, even when well; relievers act fast during symptoms or an attack.
Why does the school need a copy of the action plan?
So that staff recognise symptoms, give the reliever as agreed and know when to call for help.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Asthma in children (MedlinePlus, U.S. National Library of Medicine, 2024); Living with Asthma (asthma action plan) (Centers for Disease Control and Prevention, 2024); Asthma (fact sheet) (World Health Organization, 2025); Cuadro de procedimientos AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia) (Ministerio de Salud y Protección Social de Colombia, 2016).
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Representative model, for educational purposes only.