Acute asthma exacerbation in adults

Severity of asthma exacerbations: criteria from the Global Initiative for Asthma (GINA) guidelines​[1]Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. May 2024 [internet publication]. https://ginasthma.org/2024-report

Consider the worst feature when evaluating for severity.

Mild or moderate:

• Talks in phrases, prefers sitting to lying, not agitated

• Respiratory rate increased

• Accessory muscles not used

• Pulse rate 100 to 120 beats per minute

• Oxygen saturation (on air) 90% to 95%

• Peak expiratory flow rate (PEFR) >50% of predicted or personal best

Severe:

• Talks in words (cannot complete sentences), sits hunched forward, agitated

• Respiratory rate >30 per minute

• Accessory muscles being used

• Pulse rate >120 beats per minute

• Oxygen saturation (on air) <90%

• PEFR ≤50% of predicted or personal best

Life-threatening:

• As per severe but the patient is drowsy and/or confused and/or has a "silent chest".