your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com

Classifying asthma severity and initiating treatment in youths greater than or equal to 12 years of age and adults

Components of severity		Classification of asthma severity (≥12 years of age)
		Intermittent	Persistent
			Mild	Moderate	Severe
Impairment Normal FEV₁/FVC: 8 to 19 years 85% 20 to 39 years 80% 40 to 59 years 75% 60 to 80 years 70%	Symptoms	≤2 days/week	>2 days/week but not daily	Daily	Throughout the day
	Nighttime awakenings	≤2x/month	3 to 4x/month	>1x/week but not nightly	Often 7x/week
	Short-acting beta₂-agonist use for symptom control (not prevention of EIB)	≤2 days/week	>2 days/week but not daily, and not more than 1x on any day	Daily	Several times per day
	Interference with normal activity	None	Minor limitation	Some limitation	Extremely limited
	Lung function	Normal FEV₁ between exacerbations FEV₁ ≥80% predicted FEV₁/FVC normal	FEV₁ ≥80% predicted FEV₁/FVC normal	FEV₁ ≥60 but <80% predicted FEV₁/FVC reduced 5%	FEV₁ <60% predicted FEV₁/FVC reduced >5%
Risk	Exacerbations requiring oral systemic glucocorticoids	0 to 1/year (see footnote)	≥2/year (see footnote)
		Consider severity and interval since last exacerbation
		Frequency and severity may fluctuate over time for patients in any severity category
		Relative annual risk of exacerbations may be related to FEV₁
Recommended step for initiating treatment		Step 1	Step 2	Step 3	Step 4 or 5
				And consider short course of oral systemic glucocorticoids
		In two to six weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

Assessing severity and initiating treatment for patients who are not currently taking long-term control medications. The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs. Level of severity is determined by assessment of both impairment and risk. Assess impairment domain by patient's/caregiver's recall of previous two to four weeks and spirometry. Assign severity to the most severe category in which any feature occurs. At present, data are inadequate to correlate frequencies of exacerbations with different levels of asthma severity. In general, more frequent and intense exacerbations (eg, requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate greater underlying disease severity. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic glucocorticoids in the past year may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma.

FEV₁: forced expiratory volume in one second; FVC: forced vital capacity; ICU: intensive care unit.

Reproduced from: National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007.

Graphic 58247 Version 5.0