Asthma Management Handbook
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Table. Rapid primary assessment of acute asthma in adults and children




Can walk, speak whole sentences in one breath

(For young children: can move around, speak in phrases)

Oxygen saturation >94%

Any of these findings:

  • Use of accessory muscles of neck or intercostal muscles or 'tracheal tug' during inspiration or subcostal recession ('abdominal breathing')
  • Unable to complete sentences in one breath due to dyspnoea
  • Obvious respiratory distress
  • Oxygen saturation 90–94%

Any of these findings:

  • Reduced consciousness or collapse
  • Exhaustion
  • Cyanosis
  • Oxygen saturation <90%
  • Poor respiratory effort, soft/absent breath sounds


If features of more than one severity category are present, record the higher (worse) category as overall severity level

The severity category may change when more information is available (e.g. pulse oximetry, spirometry) or over time.

The presence of pulsus paradoxus (systolic paradox) is not a reliable indicator of the severity of acute asthma.

Oxygen saturation measured by pulse oximetry. If oxygen therapy has already been started, it is not necessary to cease oxygen to do pulse oximetry.

Oxygen saturation levels are a guide only and are not definitive; clinical judgment should be applied.

Definitions of severity classes for acute asthma used in this handbook may differ from those used in published clinical trials and other guidelines that focus on, are or restricted to, the management of acute asthma within emergency departments or acute care facilities.

Last reviewed version 2.0

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