Classify Asthma Severity
Categorizing an episode of asthma in a patient presenting to the
Emergency Department or clinic setting: all severities
| ||1 POINT||2 POINTS||3 POINTS|
|Respiratory Rate (breaths/min)|| || || |
|Oxygen saturation(%)||>95 with room air||90-95 with room air||<90 with room ari or supplemental oxygen|
|Auscultation||Normal breathing or end-expiratory wheezing||expiratory wheezing||Inspiratory and expiratory wheezing, diminished breath sounds,
|Retractions||None or intercostal||Intercostal and substernal||Intercostal, substernal and supraclavicular|
|Dyspnea||Speaks in sentences or coos and babbles||Speaks in partial sentences or utters short cries|
Speaks in single words or short phrases or grunts
Severity of Asthma
|Peak expiratory flow rate (% of predicted value)||>70||50-70||<50|
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
From: Qureshi: N Engl J Med, Volume 339(15).October 8,
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.