Asthma (including preschool asthma and viral induced wheeze) in paediatric patients

​​​​​​​​​Emergency

If any of the following are suspected, please seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary):

  • Acute respiratory illness failing to respond to treatment
  • Asthma or respiratory distress with any of the following features:
    • Apnoea
    • Cyanosis
    • Drowsiness
    • Dyspnoea
    • Haemodynamic instability
    • Intercostal or subcostal retractions
    • Oxygen saturation (SpO2) ≤ 94%
    • Poor respiratory effort
    • Signs of an impending respiratory arrest (e.g. silent chest, cardiovascular compromise, relative bradycardia or signs of child tiring)
    • Tachypnoea
    • Tracheal tug
  • Acute upper airway obstruction (e.g. sudden voice change, drooling, stridor, odynophagia)
  • Suspected inhaled foreign body and/or history of choking with persistent cough, wheeze, or recurrent pneumonia (particularly in children aged 6 months to < 5 years)

When public outpatient services are not routinely provided

  • Uncomplicated first episode of wheeze

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days
  • Aged < 12 months with persistent wheeze
  • Severe or life-threatening respiratory illness in the past 12 months requiring intensive care admission (including intensive care level of treatment outside of ICU)
  • Uncontrolled asthma despite review and mitigation of identifiable triggers and optimisation of adherence to preventer therapies (e.g. daily use of a bronchodilator reliever, such as salbutamol, use of ≥ 3 canisters of salbutamol in 12 months, or ≥ 3 courses of oral steroids in the last 6 months)

Category 2
Recommended to be seen within 90 calendar days

  • Poor asthma control despite review and mitigation of identifiable triggers and optimisation of adherence to preventer therapies, specifically:
    • Aged 1-5 years (i.e. preschool asthma): poor control on level 3 treatment (e.g. medium dose Inhaled corticosteroids (ICS))
    • Aged 6-11 years: poor control on level 4 treatment (e.g. medium dose ICS- long-acting beta agonist (LABA) combination inhaler)
    • Aged ≥ 12 years: poor control on level 3 treatment (e.g. Medium dose ICS-Formoterol maintenance and reliever therapy (MART) or medium dose ICS-LABA combination inhaler)

Notes:

  1. Refer to the Australian Asthma Handbook – Management​​​ and Medicines Guide​​

  2. Poor control is defined as:
    1. Daytime symptoms (e.g. wheeze, difficult breathing, cough)
      > 2 days per week
    2. Need for salbutamol > 2 days per week (do not include short-acting beta-2 agonist (salbutamol or terbutaline) taken prophylactically before exercise)
    3. Any limitation on daily activities
    4. Any symptoms at night (including coughing during sleep)
    5. Waking with wheezing or breathing problems
  • Recurrent asthma attacks (i.e. ≥ 2 per year) requiring hospitalisation or steroids in the last 12 months despite adherence to regular preventer medication
  • Uncertainty about diagnosis of asthma

Category 3
Recommended to be seen within 365 calendar days

  • Stable patients on monoclonal antibody treatment (e.g. Dupilumab) transferring care
    Note: should be seen within 6 months

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptom duration, severity and frequency (including any sleep, feeding or exercise related symptoms), and impact on activities of
    daily living and school attendance
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Amount and nature of asthma exacerbations, including any severe asthma attacks requiring hospital or intensive care admissions (especially if in the last 12 months)
    • Assessment of adequate adherence and inhalation technique used for asthma medication
    • Assessment of current asthma control
    • Asthma treatments trialled and clinical response
    • Barriers to therapy
    • History of prematurity
    • Known symptom triggers (e.g. cold air, exercise, pollens, viral infections)
    • Presence of comorbidities (particularly eczema, eosinophilic esophagitis, allergic rhinitis)
    • Use of and/or exposure to smoking and/or vaping

 

If available

  • Any previous spirometry +/- FeNO (Fractional exhaled Nitric Oxide) +/- skin prick testing for common aeroallergens
  • Current and previous growth parameters (including weight, length, height and head circumference)
  • Current asthma action plan
  • Symptom diary

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.


 

Current as at: Thursday 10 September 2026
Contact page owner: System Purchasing