Pediatric Asthma Score (PAS)
Quantify asthma exacerbation severity using age-adjusted respiratory rate cut points plus oxygenation and exam findings.
Last reviewed: February 26, 2026
Clinical disclaimer
PAS respiratory rate cut points are validated for ages 2 years and older.
Count for a full minute at rest when possible.
How PAS works
PAS assigns 0-3 points across five domains for a total score from 0-15: respiratory rate (age-adjusted), oxygen saturation, auscultation, retractions, and dyspnea. Higher scores indicate more severe respiratory distress.
- Use room air oxygen saturation when safe; if oxygen cannot be removed, score as requiring supplemental oxygen.
- Score dyspnea based on the child's best observed speech or cry while resting.
- Repeat the score after therapy to trend response over time.
Rapid bedside workflow
- Confirm age band and baseline oxygen support status before scoring.
- Score all PAS components from the current bedside exam and vitals.
- Pair PAS result with trajectory and response to bronchodilator/steroid interventions.
- Define next action (continue protocol tier, escalate respiratory support, or consider higher-acuity care).
- Document score components and reassessment interval for cross-shift consistency.
Respiratory rate cut points
Respiratory rate scoring uses age-specific cut points. Count for a full minute and compare to the band below.
- Age 2-3 years: 0 points 18-26, 1 point 27-34, 2 points 35-39, 3 points 40 or higher.
- Age 4-5 years: 0 points 16-24, 1 point 25-30, 2 points 31-35, 3 points 36 or higher.
- Age 6-12 years: 0 points 14-20, 1 point 21-26, 2 points 27-30, 3 points 31 or higher.
- Age over 12 years: 0 points 12-18, 1 point 19-23, 2 points 24-27, 3 points 28 or higher.
Severity interpretation
- 0-4 (Mild): consider outpatient management with bronchodilator therapy and close follow-up.
- 5-8 (Moderate): typically requires frequent bronchodilators, systemic steroids, and observation.
- 9-12 (Severe): escalate therapy, monitor closely, and consider higher-acuity care.
- 13-15 (Very severe): high risk for respiratory failure; activate escalation pathways immediately.
Thresholds and interventions vary by institution. Use PAS to standardize communication and track response to therapy.
Red flags and escalation
- Silent chest, severe fatigue, or declining mental status.
- Persistent hypoxia despite oxygen, cyanosis, or rising CO2.
- Marked accessory muscle use, impending exhaustion, or inability to speak.
- Hemodynamic instability or poor perfusion.
Reassessment cadence
- After bronchodilator or escalation step: repeat PAS in the same treatment block.
- If improving and stable: continue interval scoring per institutional asthma pathway.
- If persistent distress or deterioration: immediate re-score and escalation.
Shift handoff checklist
- Current PAS total and component drivers (RR, SpO2/oxygen need, auscultation, retractions, dyspnea).
- Interventions delivered and timing of last treatment.
- Trajectory versus prior score(s) and clinical response.
- Next reassessment time and trigger threshold for escalation.
Related calculators
References
Frequently asked questions
Most PAS tables provide age-adjusted respiratory rate cut points for children 2 years and older. Use caution in infants, and consider alternate assessment tools or institutional pathways for younger patients.
Many PAS tables recommend briefly pausing supplemental oxygen (less than 5 minutes) to assess baseline saturation if it is safe. If you cannot safely remove oxygen, score based on the need for supplemental oxygen.
Re-score after interventions (for example, after bronchodilator therapy or steroid initiation) to trend response. Use consistent timing so changes reflect clinical improvement rather than measurement variation.
PAS uses age-adjusted respiratory rate plus oxygen saturation, auscultation, retractions, and dyspnea. PRAM uses a different set of findings (air entry, suprasternal retractions, scalene muscle contraction, wheeze, oxygen) and has a separate scoring scale. Follow the tool your pathway specifies.
Chart the PAS components, treatment timing, and trend direction, not just the total score. Component-level documentation improves handoff quality and escalation timing.