Asthma Management Handbook
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Table. Secondary severity assessment of acute asthma in children 0–5 years

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 talk or vocalise

Unable to vocalise due to dyspnoea

Posture

Can walk or crawl

Lethargic

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

Normal

Tachypnoea

Bradypnoea (indicates respiratory exhaustion)

Heart rate

Normal

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

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

Normal respiratory and heart rates in children 0–5 years

 

Heart rate
(beats/minute)

Respiratory rate
(breaths/minute)

<1 year

110–160

30–40

1–2 years

100–150

25–35

2–5 years

95–140

25–30

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

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