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.
→ Salbutamol MDI via spacer: 2–4 puffs, repeat every 20 min × 3 in first hour. Oral prednisolone 1–2 mg/kg (max 40mg) if not responding. Discharge if PRAM ≤ 3 after 1 hour.
PRAM 4–7: Moderate asthma exacerbation.
→ O₂ to maintain SpO₂ ≥ 94%. Salbutamol 2.5–5mg nebulised every 20 min × 3. Ipratropium 0.25mg (< 12 yrs) nebulised. Oral prednisolone 1–2 mg/kg. Reassess after 1 hour — admit if PRAM not improving.
PRAM 8–12: Severe asthma exacerbation. Immediate treatment required.
→ High-flow O₂. Continuous nebulised salbutamol + ipratropium. IV access. IV magnesium sulfate 40mg/kg (max 2g) over 20 min. IV hydrocortisone 4mg/kg if cannot take oral. 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 et al. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr. 2000.
- 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.