Table 5.
Severity Assessment of Acute Asthma Exacerbations among Guidelines.
| GINA | BTS/SIGN | EPR3 | JPGL | |||
|---|---|---|---|---|---|---|
| 1–5 years | >5 years | 1–5 years | >5 years | |||
| SpO2 (%) | ||||||
| Mild | >95 | >95 | >95 | |||
| Moderate | 92–95 | ≥92 | 90–95 | 92–95 | ||
| Severe | <92 | <92 | <90 | <92 | ||
| Life threatening | <90 | |||||
| Heart rate (/minute) | ||||||
| Mild | ≤200 (0–3 years)
≤180 (4–5 years) |
100–120 | <100 | |||
| Moderate | ≤140 | ≤125 | 100–120 | |||
| Severe | >200 (0–3 years)
>180 (4–5 years) |
>120 | >140 | >125 | >120 | |
| Life threatening | Bradycardia | |||||
| Respiratory rate (/minute) | ||||||
| Mild | Increased | Increased | Slightly increased | |||
| Moderate | ≤40 | ≤30 | Increased | Increased | ||
| Severe | >30 | >40 | >30 | Frequently >30 | Increased | |
| Life threatening | Undetermined | |||||
| Retraction, accessory muscle use | ||||||
| Mild | Not used | Not usually | None-mild | |||
| Moderate | Commonly | Apparent | ||||
| Severe | Marked | In use | Poor respiratory effort | Usually | Marked | |
| Life threatening | Paradoxical thoracoabdominal movement | Marked | ||||
| Auscultation | ||||||
| Mild | Variable | Moderate, often only
end-expiratory wheeze |
Mild wheeze | |||
| Moderate | Loud; throughout
exhalation wheeze |
Apparent wheeze | ||||
| Severe | may be quiet | Usually loud; throughout inhalation and exhalation wheeze | Marked wheeze | |||
| Life threatening | Silent chest | Silent chest | Absence of wheeze | Reduced or eliminated | ||
| Daily life | ||||||
| Mild | Talks in sentences | Talks in sentences
Breathless while walking Can lie down |
Talks in sentences, Normal feeding,
Can sleep |
|||
| Moderate | Talks in sentences | Talks in sentences | Talks in phrases
Breathless while at rest Difficulty feeding Prefers sitting |
Talks in phrases, Difficulty feeding,
Occasionally wakes up |
||
| Severe | Talks in words or enable to drink | Cannot complete sentences in one breath or too breathless to talk or feed | Talks in words
Breathless while at rest Stop feeding, sits upright |
Talks in words,
Difficulty feeding, Disturbed sleep |
||
| Life threatening | Unable to talk | Exhaustion | Impossible to talk
Impossible to feed Disturbed sleep |
|||
| Altered consciousness | ||||||
| Mild | No altered consciousness | May be agitated | No altered consciousness | |||
| Moderate | Agitated | Usually agitated | Slightly excited
No altered consciousness |
|||
| Severe | Agitated, confused,
or drowsy |
Usually agitated | Excited
Slightly lowered consciousness |
|||
| Life threatening | Drowsy or confused | Confused | Drowsy or confused | Confused
Lowered consciousness |
||
| PEF (% predicted or % personal best) | ||||||
| Mild | >50 | ≥70 | ≥60 | |||
| Moderate | ≥50 | 40–69 | 30–60 | |||
| Severe | ≤50 | 33–50 | <40 | <30 | ||
| Life threatening | <33 | <25 | Unmeasurable | |||
GINA: Global Initiative for Asthma; GINA Report, Global Strategy for Asthma Management and Prevention
BTS/SIGN: British Thoracic Society/Scottish Intercollegiate Guidelines Network; British guideline on the management of asthma
EPR3: Expert Panel Report 3; Guidelines for the Diagnosis and Management of Asthma, National Heart, Lung, and Blood Institute
JPGL: Japanese Pediatric Guideline for the Treatment and Management of Asthma