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Table 1. The Modified Pulmonary Index Score (MPIS).

From: Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children

Score
0 1 2 3
Oxygen saturation, % >95 93–95 90–92 <90
Accessory muscle use None Mild Moderate Severe
Inspiratory-to-expiratory flow ratio 2:1 1:1 1:2 1:3
Wheezing None End
expiratory		 Inspiratory and expiratory
wheeze, good aeration		 Inspiratory and expiratory
wheeze, decreased aeration
Heart rate, (/min)
<3 years old <120 120–140 141–160 >160
≥3 years old <100 100–120 121–140 >140
Respiratory rate, (/min)
<6 years old ≤30 31–45 46–60 >60
≥6 years old ≤20 21–35 36–50 >50
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Table 2. Study Population Characteristics.

From: Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children

All ages
(N = 2,242)		 1–5 years
(N = 1,597)		 6–18 years
(N = 645)
Age (median [IQR]) 3 (2–6) 2 (1–3) 8 (7–10)
Gender (M:F) 53:47 51:49 58:42
Body temperature ≥ 38.0°C
at initial assessment (N [%])		 416 (18.6) 341 (21.4) 75 (11.6)
MPIS at initial assessment
(mean [SD])		 7.1 (3.6) 7.3 (3.5) 6.5 (3.7)
Severity of asthma (JPGL) (N [%])
Mild 862 (38.4) 591 (37.0) 271 (42.0)
Moderate 1,129 (50.4) 834 (52.2) 295 (45.7)
Severe 242 (10.8) 164 (10.2) 78 (12.1)
Respiratory failure 9 (0.4) 8 (0.5) 1 (0.2)
Disposition (N [%])
Non-admission 1,576 (70.3) 1,103 (69.1) 473 (73.3)
Hospital admission 666 (29.7) 494 (30.9) 172 (26.7)
PICU admission 8 (1.2) 5 (1.0) 3 (1.7)
Outcomes after hospital admission
Continuous inhalation required
(N [%])		 29 (4.3) 17 (3.4) 12 (7.0)
Ventilator support required
(N [%])		 8 (1.2) 5 (1.0) 3 (1.7)
Length of oxygen inhalation in days
(median [IQR]) 		3 (2–5) 3 (2–4) 3 (2–5)
Length of hospital stay in days
(median [IQR])		 5 (4–9) 5 (4–9) 6 (4–11)
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Table 3. Adjusted Risk of Hospital Admission at Initial Assessment.

From: Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children

Odds Ratio 95% Confidential
Interval		 p
Age class: 1–5 years 1.00 0.78–1.30 0.981
Body temperature: ≥38.0 1.59 1.21–2.08 <0.001
MPIS items: Score ≥2
Oxygen saturation 4.20 3.07–5.75 <0.001
Accessory muscle use 2.05 1.60–2.63 <0.001
Inspiratory-to-expiratory flow ratio 1.59 1.25–2.03 <0.001
Wheezing 2.23 1.75-2.83 <0.001
Heart rate 1.95 1.51–2.51 <0.001
Respiratory rate 2.41 1.91–3.05 <0.001
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Table 4. Predictive Validity of MPIS.

From: Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children

Age BT MPIS Sens Spec LR+ LR− PPV NPV Sens +
Spec		 AUC
All ages
All ≥12 0.291 0.968 9.182 0.732 0.795 0.764 1.260 0.825
≥11 0.428 0.924 5.667 0.619 0.705 0.793 1.352 (0.807–0.844)
≥10 0.578 0.854 3.961 0.494 0.626 0.827 1.432
≥9 0.728 0.776 3.251 0.350 0.579 0.871 1.504
≥8 0.836 0.674 2.564 0.243 0.520 0.907 1.510 *
≥7 0.899 0.576 2.122 0.175 0.473 0.931 1.476
≥38 ≥12 0.350 0.953 7.408 0.682 0.853 0.651 1.303 0.830
≥11 0.530 0.906 5.614 0.519 0.815 0.710 1.436 (0.791–0.869)
≥10 0.672 0.845 4.350 0.388 0.774 0.767 1.518 *
≥9 0.781 0.708 2.678 0.309 0.678 0.805 1.490
≥8 0.885 0.549 1.964 0.209 0.607 0.859 1.435
≥7 0.951 0.412 1.617 0.119 0.559 0.914 1.363
<38 ≥12 0.269 0.971 9.268 0.753 0.769 0.787 1.240 0.817
≥11 0.389 0.928 5.389 0.658 0.660 0.809 1.317 (0.796–0.840)
≥10 0.542 0.856 3.755 0.535 0.575 0.839 1.398
≥9 0.708 0.788 3.337 0.371 0.545 0.882 1.496
≥8 0.818 0.695 2.685 0.262 0.491 0.914 1.513 *
≥7 0.880 0.605 2.225 0.199 0.445 0.933 1.485
1–5 years
All ≥12 0.279 0.967 8.559 0.745 0.793 0.750 1.247 0.820
≥11 0.427 0.924 5.609 0.620 0.715 0.783 1.351 (0.799–0.842)
≥10 0.595 0.843 3.794 0.480 0.630 0.823 1.438
≥9 0.737 0.755 3.010 0.348 0.574 0.865 1.492 *
≥8 0.844 0.643 2.363 0.242 0.514 0.902 1.487
≥7 0.903 0.542 1.972 0.179 0.469 0.926 1.445
≥38 ≥12 0.342 0.947 6.466 0.695 0.839 0.642 1.289 0.812
≥11 0.533 0.894 5.036 0.522 0.802 0.704 1.427 (0.768–0.857)
≥10 0.664 0.825 3.806 0.407 0.754 0.754 1.490 *
≥9 0.770 0.672 2.346 0.343 0.654 0.784 1.442
≥8 0.882 0.508 1.792 0.233 0.590 0.842 1.390
≥7 0.954 0.376 1.528 0.123 0.551 0.910 1.330
<38 ≥12 0.251 0.972 8.840 0.770 0.768 0.776 1.223 0.814
≥11 0.380 0.930 5.429 0.667 0.670 0.800 1.310 (0.789–0.840)
≥10 0.564 0.847 3.684 0.514 0.580 0.839 1.411
≥9 0.722 0.772 3.174 0.360 0.543 0.881 1.495
≥8 0.827 0.671 2.513 0.257 0.485 0.912 1.498 *
≥7 0.880 0.577 2.079 0.208 0.438 0.928 1.457
6–18 years
All ≥12 0.326 0.970 11.000 0.695 0.800 0.798 1.296 0.834
≥11 0.430 0.926 5.814 0.615 0.679 0.817 1.356 (0.798–0.870)
≥10 0.529 0.879 4.390 0.535 0.615 0.837 1.409
≥9 0.703 0.825 4.009 0.360 0.593 0.884 1.528
≥8 0.814 0.746 3.208 0.249 0.538 0.917 1.560 *
≥7 0.890 0.655 2.581 0.169 0.484 0.942 1.545
≥38 ≥12 0.387 0.977 17.032 0.627 0.923 0.694 1.364 0.895
≥11 0.516 0.955 11.355 0.507 0.889 0.737 1.471 (0.814–0.976)
≥10 0.710 0.932 10.409 0.312 0.880 0.820 1.641
≥9 0.839 0.864 6.151 0.187 0.813 0.884 1.702 *
≥8 0.903 0.727 3.312 0.133 0.700 0.914 1.630
≥7 0.935 0.568 2.166 0.114 0.604 0.926 1.504
<38 ≥12 0.312 0.970 10.298 0.709 0.772 0.811 1.282 0.823
≥11 0.411 0.923 5.348 0.638 0.637 0.827 1.334 (0.783–0.863)
≥10 0.489 0.874 3.888 0.584 0.561 0.839 1.363
≥9 0.674 0.821 3.754 0.398 0.552 0.884 1.494
≥8 0.794 0.748 3.155 0.275 0.509 0.917 1.543
≥7 0.879 0.664 2.620 0.181 0.463 0.944 1.544 *
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Table 5. Severity Assessment of Acute Asthma Exacerbations among Guidelines.

From: Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children

GINA BTS/SIGN EPR3 JPGL
1–5 years >5 years 1–5 years >5 years
SpO2 (%)
Mild >95 >95 >95
Moderate 92–95 ≥92 90–95 92–95
Severe <92 <92 <90 <92
Life threatening <90
Heart rate (/minute)
Mild ≤200 (0–3 years)
≤180 (4–5 years)		 100–120 <100
Moderate ≤140 ≤125 100–120
Severe >200 (0–3 years)
>180 (4–5 years)		 >120 >140 >125 >120
Life threatening Bradycardia
Respiratory rate (/minute)
Mild Increased Increased Slightly increased
Moderate ≤40 ≤30 Increased Increased
Severe >30 >40 >30 Frequently >30 Increased
Life threatening Undetermined
Retraction, accessory muscle use
Mild Not used Not usually None-mild
Moderate Commonly Apparent
Severe Marked In use Poor respiratory effort Usually Marked
Life threatening Paradoxical thoracoabdominal movement Marked
Auscultation
Mild Variable Moderate, often only
end-expiratory wheeze		 Mild wheeze
Moderate Loud; throughout
exhalation wheeze		 Apparent wheeze
Severe may be quiet Usually loud; throughout inhalation and exhalation wheeze Marked wheeze
Life threatening Silent chest Silent chest Absence of wheeze Reduced or eliminated
Daily life
Mild Talks in sentences Talks in sentences
Breathless while walking
Can lie down		 Talks in sentences, Normal feeding,
Can sleep
Moderate Talks in sentences Talks in sentences Talks in phrases
Breathless while at rest
Difficulty feeding
Prefers sitting		 Talks in phrases, Difficulty feeding,
Occasionally wakes up
Severe Talks in words or enable to drink Cannot complete sentences in one breath or too breathless to talk or feed Talks in words
Breathless while at rest
Stop feeding, sits upright		 Talks in words,
Difficulty feeding,
Disturbed sleep
Life threatening Unable to talk Exhaustion Impossible to talk
Impossible to feed
Disturbed sleep
Altered consciousness
Mild No altered consciousness May be agitated No altered consciousness
Moderate Agitated Usually agitated Slightly excited
No altered consciousness
Severe Agitated, confused,
or drowsy		 Usually agitated Excited
Slightly lowered consciousness
Life threatening Drowsy or confused Confused Drowsy or confused Confused
Lowered consciousness
PEF (% predicted or % personal best)
Mild >50 ≥70 ≥60
Moderate ≥50 40–69 30–60
Severe ≤50 33–50 <40 <30
Life threatening <33 <25 Unmeasurable
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