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ModerateRespiratoryAcute severe asthma in childrenuk-plab-1

A 10-year-old boy with asthma presents with increased wheeze and shortness of breath not relieved by his Salbutamol inhaler. His PEFR is 45% of predicted, RR 30/min, HR 135 bpm, SpO2 93% on air, with subcostal recession. How is the severity of this asthma exacerbation best classified?

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