PRAM — Paediatric Respiratory Assessment Measure
Validated 5-item score assessing severity of acute asthma exacerbations in children aged 2–17 years.
Score interpretation
PRAM 0–3: Mild asthma exacerbation.
→ Inhaled salbutamol via spacer, repeated in the first hour as needed; oral corticosteroid if not responding fully — take doses from a children's formulary. Discharge if PRAM ≤ 3 after 1 hour.
PRAM 4–7: Moderate asthma exacerbation.
→ O₂ to maintain SpO₂ ≥ 94%. Inhaled or nebulised salbutamol every 20 min in the first hour with ipratropium; oral corticosteroid — take doses from a children's formulary. Reassess after 1 hour; admit if PRAM not improving.
PRAM 8–12: Severe asthma exacerbation. Immediate treatment required.
→ High-flow O₂. Back-to-back nebulised salbutamol with ipratropium. IV access. Consider IV magnesium sulfate; IV hydrocortisone if oral steroid cannot be taken — take doses from a children's formulary. PICU referral if no response; call anaesthetics if SpO₂ < 92% despite treatment.
Interpretation bands for the PRAM. Apply clinical judgement and local guidance.
References
- Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr. 2000;137(6):762–768.
- Ducharme FM, Chalut D, Plotnick L, et al. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr. 2008;152(4):476–480.
- BTS/SIGN British Guideline on the Management of Asthma. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Salbutamol (Paediatric — Asthma/Wheeze) · Short-Acting Beta-2 Agonist (SABA)
- Prednisolone (Paediatric) · Corticosteroid — Asthma Exacerbation / Croup / Nephrotic Syndrome / IBD
- Montelukast (Paediatric) · Leukotriene Receptor Antagonist — Asthma Prophylaxis / Allergic Rhinitis
- Poractant Alfa (Porcine Surfactant) · Lung Surfactant (Respiratory Distress Syndrome — Neonatal)
- Doxapram hydrochloride · Respiratory stimulant
- Tezepelumab (CRSwNP / Severe Asthma) · Anti-TSLP (Thymic Stromal Lymphopoietin) Monoclonal Antibody
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.