This professional development program pertains to the Pediatric Respiratory Assessment Measure ("PRAM"), a clinical score developed and validated for children aged 1-17 years. The PRAM serves to assess the severity of an asthma exacerbation and its response to treatment to apply severity-specific treatment in conformity with national and international guidelines.

THE PRAM TEACHING MODULE IS DESIGNED ONLY FOR PROFESSIONAL DEVELOPMENT. THE PRAM SCORE IS INTENDED TO BE USED IN THE CLINICAL ASSESSMENT OF THE SEVERITY OF AN EPISODE OF ACUTE AIRWAY OBSTRUCTION DUE TO ASTHMA. IT IS AN AID TO THE CLINICAL ASSESSMENT AND SHALL NOT BE USED TO REPLACE OR OVERRULE A LICENSED HEALTH CARE PROFESSIONAL'S JUDGEMENT ABOUT ASTHMA SEVERITY.

All copyright and other intellectual property rights in the PRAM and the PRAM Teaching Module are the sole and exclusive property of Dr. Francine M. Ducharme. Any unauthorized use, copy or modification of the PRAM Teaching Module is strictly forbidden.

National and international guidelines on the treatment of an acute asthma exacerbation vary according to the severity of airway obstruction. An accurate assessment of severity is therefore essential.

Although spirometry is recognized as the gold standard for assessing asthma severity, close to 100% of preschoolers and almost 50% of school-aged children cannot reproducibly perform the manoeuvre required for spirometry during an acute asthma exacerbation.

A clinical score offers an interesting alternative because it is applicable to all, irrespective of the child’s age.

The PRAM score correlates with airway resistance.¹ A change in PRAM score correlates with a change in airway resistance. Moreover, the PRAM score measured at triage predicts the rate of hospital admission2 and has been classified into three severity levels as follows:

The hospitalisation rate of children with a PRAM of 0 to 3 (mild obstruction) is inferior to 10%. It is between 10% and 40% those with a PRAM of 4 to 7 (moderate obstruction) and superior to 50% for those with a PRAM of 8 to 12 (severe obstruction)

¹ Chalut DS et al. J Pediatr. 2000;137(6):762-8
² Ducharme FM et al. J Pediatr. 2008;152(4):476-80, 480.e1

The aim of this teaching module is to facilitate the acquisition of skills to accurately assign the PRAM score in acutely ill children, in order to apply severity-specific treatment in conformity with national guidelines.

Following completion of this online module, you will be able to:

1. Recognize the five criteria of the Pediatric Respiratory Assessment Measure (PRAM);
2. Assign the PRAM score accurately and precisely in children aged 1-17 years;
3. Establish a PRAM score, regardless of the severity of the asthma exacerbation, the asymmetry in pulmonary auscultation, or any other pitfalls in the physical examination;
4. Assess the level of asthma severity (mild, moderate, severe) using the PRAM score;
5. Apply the PRAM score in your own clinical practice to assess the severity of an acute exacerbation and the response to treatment 

Potential conflicts of interest of Scientific Committee Members

In the past 2 years, Dr Francine Ducharme has received research funds from Jamieson, Scotia Bank Foundation, Covis Pharma, GlaxoSmithKline et MEDteq in partnership with Thorasys Inc.; honoraria for consultancy work from Astra Zeneca, Covis Pharma, Sanofi, Teva, and Thorasys Inc.; honoraria as invited speaker from Association des Médecins omnipraticiens du Richelieu Saint-Laurent, Covis Pharma, Réseau Québécois sur l’asthme et la MPOC, Sanofi, and Thorasys Inc. Drs Serge Gouin, Anab Lehr, Martha McKinney and Richard Ratelle declare no conflict.