An 8-year-old with severe acute asthma signs (peak flow 45%, SpO2 89%, HR 132, RR 33). What is the correct action?

• A. Administer inhaler and monitor
• B. Wait 15 minutes
• C. Call GP
• D. Refer to A&E

Answer: (D)

This situation shows a severe acute asthma attack in a child, where immediate escalation is essential. A peak flow of 45% of the predicted value indicates substantial airflow limitation, and an SpO2 of 89% reveals hypoxaemia. Coupled with tachycardia (HR 132) and tachypnoea (RR 33), these signs point to significant respiratory distress with risk of rapid deterioration. In children, such red flags require urgent assessment in an emergency setting so they can receive rapid bronchodilator therapy, supplemental oxygen to correct low oxygen levels, systemic steroids, and close monitoring. Waiting or managing in primary care would risk progression to a life-threatening situation, while simply delaying with a GP visit would be inappropriate. Refer to A&E for immediate, comprehensive treatment and monitoring.