Assessment of Asthma Acuity

Before children can receive appropriate treatment for uncontrolled asthma, it is essential to assess accurately the severity of their symptoms.

• Accessory muscle use –Look for the presence of indrawing; subcostal or intercostal muscle retractions. 
• Dyspnea – The impression of the nurse that the child is breathless or having a difficult time breathing such as too breathless to complete a sentence or to feed. 
• Increased respiratory rate when child is afebrile.
• Cerebral function – The child may display increased agitation or a decreased level of consciousness.  Lung function for children 5 years and older – If possible, objective lung function measurements should be determined by spirometry (Forced Expiratory Volume in one second) or peak expiratory flow rates. A value < 50% requires medical attention. 
• Decrease in oxygen saturation – If a pulse oximeter is available, the level of oxygen saturation should be determined. An acceptable level of oxygen saturation is >92%.

If the child exhibits any of the above symptoms, they should be referred for immediate medical attention