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Severity of Asthma Exacerbation

 

 

 

Mild

 

 Moderate 

 

Severe

 

Respiratory Rate  

 

 

2-3 yrs: <34/min  

4-5 yrs: <30/min 

6-12 yrs: <26/min 

>12 yrs: <23/min 

 

 

2-3 yrs: 35-39/min 

4-5 yrs: 31-35/min 

6-12 yrs: 27-30/min 

>12 yrs: 24-27/min 

 

 

2-3 yrs: >40/min 

4-5 yrs: >36/min 

6-12 yrs: >31/min 

>12 yrs: >28/min 

 

 

Pulse Oximetry (SpO2) Requirement 

 

>95% on room air 

 

90-95% on room air 

 

<90% on room air 

 

 

Auscultation 

 

 

Normal or end expiratory wheeze 

 

 

Expiratory wheezing 

 

 

Inspiratory and expiratory wheeze or diminished breath sounds 

 

 

Retractions 

 

 

None or intercostal 

 

 

Intercostal and substernal 

 

 

Intercostal, substernal, and supraclavicular 

 

 

Dyspnea 

 

 

Speaks in sentences 

 

 

Speaks in partial sentences 

 

 

Speaks in single words or short phrases 

 

 

Patients may not display all signs/symptoms in a single column. Clinical judgment is essential to the assessment of severity. 

 

Scoring Reference 

(Mild symptoms = 1; Moderate symptoms = 2; Severe symptoms = 3) 

Pediatric Asthma Score 

5-7 

8-11 

12-15 

Kelly CS, Andersen CL, Pestian JP. Improved outcomes for hospitalized asthmatic children using a clinical pathway. Ann Allergy Asthma Immunol. 2000;84(5):509–516 

 

 

These pathways 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 a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.