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The most important cause of death in an asthmatic is failure to identify severe exacerbation of disease. There are various scores to diagnose severity of asthma. Following features are seen in a patient who has Severe acute symptoms :

Sensorium - Irritable or drowsy

Speech - Unable to talk more than a few words at a time.

Posture - Sit up leaning forward with support of back with hands (tripod) or Limp.

Color - Cyanosis, pale, sweating

Use of accessory muscles of respiration

Respiratory rate - Tachypnoea or decreasing respiratory rate.

Pulse - pulsus paradoxus, tachycardia hypotension.

Chest findings - Loud wheeze, absence of wheeze, reduced air entry

O2 Saturation - less than 90 - 92 % in room air

PEFR - less than 30 - 50 % of normal

Wheeze need not be present for diagnosis of asthma. If there is not a firmly established alternative diagnosis asthma should be considered when patients present with following symptoms:

Recurrent/chronic lower respiratory tract wheezing

Recurrent/chronic cough

Repeated diagnosis of bronchitis

Repeated diagnosis of pneumonia not consistent with pyogenic infections

The diagnosis may be confirmed by demonstrating the complete response of symptoms, or spirometric measurement of airway obstruction, to an inhaled ? agonist and/or 5 to 10 day course of oral steroids.