🚨 TIME-CRITICAL β€” IMMEDIATE TRANSFER WITH ATMIST PRE-ALERT
Asthma
Assessment
Adults & Children Β· JRCALC Β· G0380 v25.58
🚨 SILENT CHEST IS A PRE-TERMINAL SIGN. Severity is often under-recognised. Assess carefully.
⚠️ Asthma is predominantly a disease of EXHALATION. Do not over-ventilate. Ensure adequate expiration.
ℹ️ Asthma is rare under 1 year β€” consider bronchiolitis or viral-induced wheeze. Consider anaphylaxis if sudden onset with no asthma history.
Patient Age Group
Adult
Post-puberty Β· HR threshold >110 Β· RR threshold >25
Child over 5 years
HR threshold >125 Β· RR threshold >30
Child 1–5 years
HR threshold >140 Β· RR threshold >40
Under 1 year
⚠️ Asthma rare β€” consider alternative diagnosis
Time-Critical Screen β€” Check Immediately
If ANY of these are present β€” START CORRECTING, IMMEDIATE TRANSFER, ATMIST PRE-ALERT. Continue management en-route.

🚨 Time-Critical Features

Severity Classification
Select the severity level that best matches the clinical picture. Any single feature moves the patient to that category.
⚑ Life-Threatening
Any ONE of: Altered consciousness Β· Exhaustion Β· Cyanosis Β· Silent chest Β· Poor respiratory effort Β· PEF <33% Β· SpOβ‚‚ <92% Β· Arrhythmia Β· Hypotension
πŸ”Ά Acute Severe
PEF 33–50% Β· Unable to complete sentences in one breath Β· HR: Adult >110, Child >5y >125, Child 1-5y >140 Β· RR: Adult >25, Child >5y >30, Child 1-5y >40
🟑 Moderate
PEF 50–75% best/predicted Β· Able to speak in sentences Β· Increasing symptoms Β· No features of acute severe asthma
🟒 Mild
Below best level of functioning due to wheeze Β· PEFR >75% best or predicted Β· No features of moderate or acute severe asthma
☠️ Near-Fatal
Requiring mechanical ventilation with increased inflation pressures Β· Hypercapnia Β· Respiratory arrest
Peak Expiratory Flow Rate
⚠️ Do NOT perform PEFR in severe or life-threatening attacks β€” may exacerbate. PEFR before AND after nebulised treatment in mild-moderate.
No place for PEFR in pre-school children β€” they cannot reliably perform this task.

PEFR Calculator

Patient's best / known PEFR
L/min (leave blank to use predicted)
Measured PEFR now
L/min

Adult Predicted PEFR Reference

Predicted values vary by age, sex and height. Enter patient's known best if available β€” this is more accurate than predicted.

Typical adult predicted values: Female ~380–450 L/min Β· Male ~480–600 L/min Β· Peak around age 25–35 then declines with age.

Paediatric Predicted PEFR

Height
1.25m / 4'1"
192 L/min
Height
1.35m / 4'5"
233 L/min
Height
1.45m / 4'9"
276 L/min
Height
1.50m / 4'11"
299 L/min
Height
1.55m / 5'1"
323 L/min
Height
1.60m / 5'3"
346 L/min
Treatment Pathway
Event Log
No events logged yet.
Near-Fatal Asthma β€” Risk Factors
Patients with severe asthma AND one or more of these risk factors are at GREATER risk of death. Tap to flag.

Medical Risk Factors

Previous near-fatal asthma Previous ICU admission Previous hospital admission for asthma 3+ classes of asthma medication High Ξ²2 agonist requirements Poor response to Ξ²2 agonists Repeated ED attendances Brittle asthma Anaphylaxis history

Psychosocial Risk Factors

Non-compliance with treatment Failure to attend appointments Self-discharge from hospital Psychiatric illness / depression Deliberate self-harm Major tranquilliser use Alcohol or drug misuse Obesity Smoking Learning difficulties Social isolation Severe domestic / legal stress Denial
Asthma
Summary
JRCALC Β· Aide-memoire only β€” complete full PCR separately
⚠️ Aide-memoire only. Complete full PCR separately.
Plain Text β€” PCR / Handover