Pediatric Asthma Score (PAS)

Mild (PAS 5-7)

• Consider de-escalation of current therapy. Consider spacing of albuterol and interval assessments, or preparation for discharge if tolerating home controller regimen.

Moderate (PAS 8-11)

• Continue current treatment and interval assessment.

Severe (PAS 12-15)

• Consider escalation of treatment, including increasing frequency of nebulizer treatments, adding another controller medication (e.g. ipratropium bromide, terbutaline), and transfer to monitored unit.

• The authors used a therapy-driven protocol derived from review of asthma practice patterns in the hospital, NHLBI guidelines, and a review of literature regarding inpatient management of status asthmaticus. The protocol was designed to use either the PAS or PEFR to measure response.
• Another example of a pathway for management of asthma in the inpatient setting: Children's Hospital of Philadelphia Inpatient Asthma Pathway

• Always assess airway, breathing, and circulation prior to assessing PAS.  The PAS was not developed for use on unstable patients and emergent intervention must not be withheld to determine the score.
• Any patient being treated for asthma exacerbation should receive steroids in addition to nebulized albuterol unless there is a contraindication.
• Prior to discharge, every patient and their family should receive education on use of home inhalers and/or nebulizers, an asthma action plan, and scheduled follow-up with their primary care physician.  Ensure the patient has adequate supply of home controller medications, peak flow meter, and spacer if applicable.