Asthma Management Handbook
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Table. Secondary severity assessment of acute asthma in adults and children 6 years and over

Note: If features of more than one severity category are present, record the higher category as overall severity level

 

Mild/Moderate (all of):

Severe (any of):

Life-threatening (any of):

Speech

Can finish a sentence in one breath

Can only speak a few words in one breath

Can’t speak

Posture

Can walk

Unable to lie flat due to dyspnoea

Sitting hunched forward

Collapsed or exhausted

Breathing

Respiratory distress is not severe

Paradoxical chest wall movement: inward movement on inspiration and outward movement on expiration (chest sucks in when person breathes in)

or

Use of accessory muscles of neck or intercostal muscles or ‘tracheal tug’ during inspiration

or

Subcostal recession (‘abdominal breathing’)

Severe respiratory distress

or

Poor respiratory effort

Consciousness

Alert

Drowsy or unconscious

Skin colour

Normal

Cyanosis

Respiratory rate

<25 breaths/min

≥25 breaths/min

Bradypnoea (indicates respiratory exhaustion)

Heart rate

Adults: <110 beats/min

Children: normal range

Adults: ≥110 beats/min

Children: tachycardia

Cardiac arrhythmia

or

Bradycardia (may occur just before respiratory arrest)

Chest auscultation

Wheeze

or

Normal lung sounds

Silent chest

or

Reduced air entry

Oxygen saturation (pulse oximetry)

>94%

90–94%

<90%

or

Clinical cyanosis

Blood gas analysis (adults, if performed) 

Not indicated

Not indicated

PaO2 <60 mmHg

PaCO2 >50 mmHg§ 

PaCO2 within normal range despite low PaO2

pH <7.35# 

† Not applicable – may be the same as moderate and does not determine severity category

‡ Perform blood gas analysis only if clinically indicated

§ The presence of hypercapnoea indicates that the patient is tiring and may need ventilatory support.

# Metabolic acidosis (often associated with hypokalaemia) may occur with increased work of breathing and with high-dose salbutamol.

Normal respiratory and heart rates in children

 

Heart rate
(beats/minute)

Respiratory rate
(breaths/minute)

5–12 years

80–120

20–25

12–18 years

60–100

15–20

Source: Samuels M, Wieteska S. (Eds) Advanced paediatric life support: the practical approach. 5th edn. Wiley-Blackwell, Oxford; 2011.

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