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Annotations Evaluate the Patient

Evaluate the Patient

Collect data for Categorization of Episode Severity

Measurement of pulse oximetry: Spot check

Do it

Measurement of respiratory rate

Do it

Auscultation of lungs

Do it

Observe for the presence of retractions and dyspnea

Do it

Peak flow measurement in patients capable of doing this

Probably don't do it

Categorize Asthma Episode Severity 

Categorizing an episode of asthma in a patient: all severities (Do it)



1 point

2 points

3 points

Respiratory Rate


2 - 3 years

< 34

35 - 39

> 40

4 - 5 years

< 30

31 - 35

> 36

6 - 12 years

< 26

27 - 30

> 31

> 12 years

< 23

24 - 27

> 28

Oxygen saturation (%)

>95 with room air

90-95 with room air

<90 with room air or supplemental oxygen


Normal breathing or end-expiratory wheezing

Expiratory wheezing

Inspiratory and expiratory wheezing, diminished breath sounds, or both


None or Intercostal

Intercostal &


Intercostal, Substernal, & Supraclavicular


Speaks in sentences or coos and babbles

Speaks in partial sentences or utters short cries

Speaks in single words or short pants or grunts


Severity of Asthma





Peak expiratory flow rate (% of predicted value) +




Asthma score*




*The overall asthma score (range, 5 to 15 points) was calculated by adding the scores for each of the five variables: respiratory rate, oxygen saturation, 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, 1998.1030-1035The 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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