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تعداد آیتم قابل مشاهده باقیمانده: 4

Formal evaluation of asthma exacerbation severity in the urgent or emergency care setting

Formal evaluation of asthma exacerbation severity in the urgent or emergency care setting
  Mild Moderate Severe Subset: Respiratory arrest imminent
Symptoms
Breathlessness While walking While at rest (infant - softer, shorter cry, difficulty feeding) While at rest (infant - stops feeding)  
Can lie down Prefers sitting Sits upright  
Talks in Sentences Phrases Words  
Alertness May be agitated Usually agitated* Usually agitated* Drowsy or confused
Signs
Respiratory rate Increased Increased Often >30/minute Poor respiratory effort, appears exhausted
Guide to rates of breathing in awake children:
Age Normal rate
  • <2 months
 <60/minute
  • 2 to 12 months
 <50/minute
  • 1 to 5 years
 <40/minute
  • 6 to 8 years
 <30/minute
Use of accessory muscles; suprasternal retractions Usually not Commonly Usually Paradoxical thoracoabdominal movement
Wheeze Moderate, often only end expiratory Loud; throughout exhalation Usually loud; throughout inhalation and exhalation Absence of wheeze (silent chest)
Pulse/minute <100 100 to 120 >120 Bradycardia
Guide to normal pulse rates in children:
Age Normal rate
  • 2 to 12 months
 <160/minute
  • 1 to 2 years
 <120/minute
  • 2 to 8 years
 <110/minute
Pulsus paradoxus Absent to <10 mmHg

May be present

10 to 25 mmHg

 Often present

>25 mmHg (adult)

20 to 40 mmHg (child)

 Absence suggests respiratory muscle fatigue
Other       Cyanosis
Functional assessment
PEF percent predicted or percent personal best ≥70% Approximately 40 to 69% or response to inhaled beta-agonists lasts <2 hours <40%

<25%

NOTE: PEF testing may not be needed in very severe attacks
PaO2 (in room air) Normal (test not usually necessary) ≥60 mmHg (test not usually necessary) <60 mmHg: possible cyanosis  
PCO2 <42 mmHg (test not usually necessary) <42 mmHg (test not usually necessary) ≥42 mmHg: possible respiratory failure  
SpO2 percent (in room air) at sea level >95% (test not usually necessary) 90 to 95% (test not usually necessary) <90%  
Hypercapnia (hypoventilation) develops more readily in young children than in adults and adolescents.
BP Hypotension
NOTES:
  • The presence of several parameters, but not necessarily all, indicates the general classification of the exacerbation.
  • Many of these parameters have not been systematically studied, especially as they correlate with each other. Thus, they serve only as general guides.[1-11]
  • The emotional impact of asthma symptoms on the patient and family is variable, but must be recognized and addressed and can affect approaches to treatment and follow-up.[12-14]

BP: blood pressure; PaO2: arterial oxygen pressure; PCO2: partial pressure of carbon dioxide; PEF: peak expiratory flow; SpO2: oxygen saturation.

* Some children with an acute severe asthma exacerbation do not appear agitated.

References:
  1. Cham GW, Tan WP, Earnest A, Sohn CH. Clinical predictors of acute respiratory acidosis during exacerbation of asthma and chronic obstructive pulmonary disease. Eur J Emerg Med 2002; 9:225.
  2. Chey T, Jalaludin B, Hanson R, Leeder S. Validation of a predictive model for asthma admission in children: How accurate is it for predicting admissions? J Clin Epidemiol 1999; 52:1157.
  3. Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med 2004; 11:10.
  4. Karras DJ, Sammon ME, Terregino CA, et al. Clinically meaningful changes in quantitative measures of asthma severity. Acad Emerg Med 2000; 7:327.
  5. Kelly AM, Powell C, Kerr D. Patients with a longer duration of symptoms of acute asthma are more likely to require admission to the hospital. Emerg Med (Fremantle) 2002; 14:142.
  6. Kelly AM, Kerr D, Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma? Respir Med 2004; 98:777.
  7. Keogh KA, Macarthur C, Parkin PC, et al. Predictors of hospitalization in children with acute asthma. J Pediatr 2001; 139:273.
  8. McCarren M, Zalenski RJ, McDermott M, Kaur K. Predicting recovery from acute asthma in an emergency diagnostic and treatment unit. Acad Emerg Med 2000; 7:28.
  9. Rodrigo C, Rodrigo G. Therapeutic response patterns to high and cumulative doses of salbutamol in acute severe asthma. Chest 1998; 113:593.
  10. Rodrigo GJ, Rodrigo C, Hall JB. Acute asthma in adults: A review. Chest 2004; 125:1081.
  11. Smith SR, Baty JD, Hodge D III. Validation of the pulmonary score: An asthma severity score for children. Acad Emerg Med 2002; 9:99.
  12. Ritz T, Steptoe A, Dewilde S, Costa M. Emotions and stress increase respiratory resistance in asthma. Psychosom Med 2000; 62:401.
  13. Strunk RC, Mrazek DA. Deaths from asthma in childhood: Can they be predicted? N Engl Reg Allergy Proc 1986; 7:454.
  14. von Leupoldt A, Dahme B. Emotions and airway resistance in asthma: Study with whole body plethysmography. Psychophysiology 2005; 42:92.

Reproduced from: National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.

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