A chest x ray examination is often performed in the assessment of the acute asthmatic patient to examine for evidence of infection or the complications of hyperinflation pneumothorax or pneumomediastinum however there are no objective data to support this routinely. Your assessment and management should be documented clearly in the notes however this should not delay initial clinical assessment investigations and interventions initial steps acute scenarios typically begin with a brief handover from a member of the nursing staff including the patients name age background and the reason the review has been requested. The most important parameters in the assessment of the severity of acute childhood asthma are general appearance mental state and work of breathing accessory muscle use recession initial spo 2 in air heart rate and ability to talk are helpful but less reliable additional features. In patients with pre existing asthma a thorough history and structured review can help distinguish an asthma exacerbation from covid 19 and guide management in those with symptoms of acute asthma corticosteroids can and should be used if indicated and not withheld on the basis of suspected covid 19 as a trigger