Child Health  |  Asthma Pathway - Acute Asthma Severity Tool




Child Health

Asthma Pathway - Acute Asthma Severity Tool

Asthma Severity Score (ASS)
Add wheeze and muscle subtotals to give score

                                                      Score

Wheeze (beware of silent chest*)

None  (0)

 

Expiratory (by auscultation)  (1)

 

Expiratory & inspiratory  (2)

 

Heard without stethoscope  (3)

 

Sub Total

 

Accessory muscle use / indrawing

None  (0)

 

Mild  (1)

 

Moderate  (2)

 

Severe  (3)

 

Sub Total

 

TOTAL

 

 

0-2 = Mild
3-4 = Moderate
5-6 = Severe

 

Acute Mild

  • Speaks/feeds normally

  • Pulse normal

  • Respiratory rate normal

  • Mild indrawing

 Acute Moderate

  • Speaking/feeding interrupted by breaths

  • Indrawing/accessory muscle use present

  • Pulse 1 to 5 years >110/min


Over 5 years >100/min

  • Respiration counted over 60 seconds

1 to 5 years >40/min

Over 5 years >20/min

 Acute Severe

  • Can't complete sentences in one breath, or too breathless to talk or feed

  • Pulse 1 to 5 years >130/min


Over 5 years >120/min

  • Respiration counted over 60 seconds

1 to 5 years >50

Over 5 years >30

  • Indrawing /accessory muscle use obvious

Acute Life Threatening

  • Hypotension
  • Exhaustion
  • Confusion
  • Coma
  • Silent chest
  • Cyanosis

 

Recognition of Life-threatening Asthma

  • Respiratory - hypoxia/exhaustion
  • Neurological - agitation, confusion, drowsiness
  • Cardiovascular - pulsus paradoxus, worsening tachycardia
  • Consider diagnoses other than asthma, especially in infants with poorly responsive respiratory distress
  • In very severe cases, because of extremely poor air entry, you may not hear wheeze
  • Deterioration despite maximal therapy on severe asthma pathway

Oxygen saturations can remain normal in life-threatening asthma.


Severe Asthma

  • Too breathless to talk or feed
  • HR > 120/min (>5years) or > 130/min (2-5 years)
  • Marked accessory muscle use 


Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.