Respiratory Score for Asthma

• This tool should be used as part of a comprehensive assessment; clinical judgment remains essential.
• Use initial and follow-up scores to guide treatment intensity and disposition decisions.
• Lower scores may indicate the need for less intensive therapy, while higher scores may require escalated therapy, respiratory support, admission, or critical care.

The following is a basic example of how the Respiratory Score can be used in the ED. Please refer to your institution’s protocols for more detailed guidance, such as the Seattle Children’s Hospital algorithm.

• Low risk (score 0–4):
  
  • For initial management, consider systemic corticosteroids and bronchodilator therapy.
  • Rescore frequently (e.g., hourly).
  • If scores remain low with good response to therapy, stable oxygenation, and the absence of worsening symptoms, the patient may be appropriate for discharge.
• Moderate risk (score 5–8):
  
  • For initial management, provide systemic corticosteroids and bronchodilator therapy.
  • Rescore frequently.
  • If the score decreases to the low-risk category, the patient may be appropriate for discharge or short observation, depending on the clinical context.
  • If the score remains in the moderate category after several hours of therapy, continue bronchodilator therapy and consider inpatient management.
• High risk (score 9–12):
  
  • For initial management, consider systemic corticosteroids, intensive bronchodilator therapy, and magnesium sulfate.
  • Rescore frequently.
  • If the score decreases to the low-risk category, consider a short observation period prior to discharge.
  • If the score remains in the moderate or high-risk categories, continue therapy and consider inpatient management. 
  • Patients with persistently high scores (≥9) should be strongly considered for ICU admission for closer monitoring and advanced interventions, particularly if signs of impending respiratory failure are present.

• Although this score does not utilize SpO₂ in its calculations, monitoring oxygen saturation is recommended for patients with acute asthma exacerbations.
• Be sure to monitor for other signs of clinical deterioration, such as drowsiness, confusion, and hypercapnia.
• Consider early consultation with ICU teams for patients with persistent distress despite therapy or signs of impending respiratory failure.