Asthma assessment and severity

• Asthma severity

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Assessment should focus on:

History of the current presentation

• Symptom onset, infective symptoms, triggers and current medications

Previous asthma history

• ICU admissions, previous NIV/intubation, respiratory specialist input

Identification of risk factors for poor asthma outcomes

• Prior intubation, prior ICU admission, chronic steroid use, other comorbidities, recent ED care, psychosocial problems, poor compliance, poor follow up

Physical examination

• Qualify the severity of the acute attack; mild/moderate, severe or life-threatening

In line with the new National Asthma Council Guidelines 2019, spirometry should be performed in all patients within the first hour where practical but this no longer forms part of the initial asthma severity assessment criteria. Peak flow is less reliable and underestimates the severity of airflow limitation in patients with acute asthma compared to FEV1.

CXR and blood gases should only be performed if clinically indicated and are usually unnecessary in those presenting with mild/moderate asthma.