sign101

British Guideline on the MAnAGeMent of AsthMA
68
Table 12: Clinical features for assessment of severity 800
life
threatening
asthma
Acute severe
asthma
Moderate
asthma
exacerbation
Any one of the following in a child with severe asthma:
Clinical signs Measurements
Silent chest SpO 5 years
Respiration >40 breaths/min aged 2-5 years
>30 breaths/min aged >5 years
Able to talk in sentences
SpO ≥92%
2
PEF ≥50% best or predicted
Heart rate ≤140/min in children aged 2-5 years
≤125/min in children >5 years
Respiratory rate ≤ 40/min in children aged 2-5 years
≤ 30/min in children >5 years
Before children can receive appropriate treatment for acute asthma in any setting, it is essential
to assess accurately the severity of their symptoms. The following clinical signs should be
recorded:
Pulserate
(increasing tachycardia generally denotes worsening asthma; a fall in heart rate in life
threatening asthma is a pre-terminal event)
Respiratory rate and degree of breathlessness
(ie too breathless to complete sentences in one breath or to feed)
Use of accessory muscles of respiration
(best noted by palpation of neck muscles)
Amount of wheezing
(which might become biphasic or less apparent with increasing airways obstruction)
Degree of agitation and conscious level
(always give calm reassurance).
Clinical signs correlate poorly with the severity of airways obstruction. 450-453 Some children with
acute severe asthma do not appear distressed.
; Decisions about admission should be made by trained clinicians after repeated assessment
of the response to bronchodilator treatment.
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