If there is no clinical response within 20 minutes of giving an inhaled bronchodilator, repeat the dose, give a dose of oral steroids and refer the child to hospital for further treatment. Also consider transfer to hospital if the child refuses fluids, becomes restless or lethargic, or becomes cyanosed. Give oxygen during transfer.

The management of acute asthma in hospital consists of:

1. Nebulised or inhaled bronchodilators every hour.
2. A short course of oral steroids for 7 days (e.g. oral prednisone 2 mg/kg daily).
3. Reassess hourly. If no response consider admission for intensive care.