ASTHMA - ASSESSMENT OF SEVERITY

see Normal paediatric vital signs (or children, adult pulse rate criteria cannot be applied)

() denote adult values

(modified from The Australian Asthma Management Handbook)
Clinical features Mild Moderate *Severe and life-threatening
Airway Speech Sentences Phrases Words 
Breathing RR (breaths/min) < 30% x normal
(< 20)
30-50% x normal
(20-40)
> 50% x normal
(> 40)
Accessory mm. use
Retractions
Nil/Mild Moderate Marked
Wheeze Expiratory only Inspiratory/Expiratory Silent
SpO2 > 94% 94-90% < 90%
Circulation Pulse rate (100-120) (> 120)
Colour Absent Mild cyanosis or pale Marked cyanosis
Disability Conscious state Normal Normal Drowsy
Physical exhaustion No No Yes/Paradoxical chest wall movement
Other Pulsus paradoxus Not palpable May be palpable Palpable#
Peak expiratory flow
(% predicted)
> 60%
(>200 L/min)
40-60%
(80-200 L/min))
< 40% (often unable to perform)
FEV1 (% predicted) > 60%
(>1.5 L/min)
40-60%
(1-1.5 L/min)

< 40% (often unable to perform)
(1-1.5 L/min)

ABG 
pO2
pCO2
> 80mmHg
< 60mmHg
60-80mmHg
35-40mmHg
< 60mmHg
> 45 mmHg

# CYANOSIS AND PARADOXICAL PULSE MAY BE ABSENT, BUT WHEN PRESENT INDICATE SEVERE OBSTRUCTION

*Any of these features indicates that the episode is severe. The absence of any feature does not exclude a severe attack.
+ Patient may be incapable of performing test.