The PRAM grades asthma exacerbation severity in children, helping guide treatment decisions in the emergency or urgent-care setting.
Mild exacerbation.
Moderate exacerbation.
Severe exacerbation.
Children can't always reliably perform peak flow or spirometry, especially younger kids, so PRAM relies on observable clinical signs instead.
Roughly: 0–3 mild, 4–7 moderate, and 8–12 severe exacerbation, guiding treatment intensity in the emergency or urgent-care setting.
Minimal or absent air movement — paradoxically scored highest for both air entry and wheezing because it signals airflow so limited that little sound is produced. It's an ominous sign.
It's re-scored after treatment (bronchodilators, steroids) to track response and guide decisions about admission or discharge.