Annotations Categorize Episode Severity

Categorize Episode Severity

Classify Asthma Severity 

Categorizing an episode of asthma in a patient presenting to the Emergency Department or clinic setting: all severities  Do it 

Variable

Asthma Scoring 

 1 POINT2 POINTS3 POINTS
Respiratory Rate (breaths/min)   
2-3 yr<=3435-39>=40
4-5 yr<=3031-35>=36
6-12 yr<=2627-30>=31
>12 yr<=2324-27>=28
Oxygen saturation(%)>95 with room air90-95 with room air<90 with room ari or supplemental oxygen
AuscultationNormal breathing or end-expiratory wheezingexpiratory wheezingInspiratory and expiratory wheezing, diminished breath sounds, or both
RetractionsNone or intercostalIntercostal and substernalIntercostal, substernal and supraclavicular
DyspneaSpeaks in sentences or coos and babblesSpeaks in partial sentences or utters short cries

Speaks in single words or short phrases or grunts



 Severity of Asthma 

 MildModerateSevere
Peak expiratory flow rate (% of predicted value)>7050-70<50
Asthma Score5-78-1112-15

The overall asthma score (range 5 to 15 points) was calculated by adding the scores for each of five variables: respiratory rate, oxygen saturaction, auscultation, retractions, and dyspnea. The overall asthma score was then used to stratify children according to the severity of disease.

When the peak expiratory flow rate was known and reliable, it, rather than the asthma score, was used to stratify the children according to severity.

Methods of Calculating the Asthma Score and the Severity of Asthma.
From: Qureshi: N Engl J Med, Volume 339(15).October 8, 1998.1030-1035

The Qureshi categorization system is reasonably consistent with systems recommended by the Expert Panel Report of the National Heart, Lung, and Blood Institute, 1991 and Becker, et al. The Pulmonary Index. AJDC. 1984; 138: 574-76.


These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.

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