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Assessing asthma control in youths greater than or equal to 12 years of age and adults

Components of control		Classification of asthma control (youths ≥12 years of age and adults)
Components of control		Well controlled	Not well controlled	Very poorly controlled
Impairment	Symptoms	≤2 days/week	>2 days/week	Throughout the day
	Nighttime awakenings	≤2x/month	1 to 3x/week	≥4x/week
	Interference with normal activity	None	Some limitation	Extremely limited
	Short-acting beta₂-agonist use for symptom control (not prevention of EIB)	≤2 days/week	>2 days/week	Several times per day
	FEV₁ or peak flow	>80 percent predicted/personal best	60 to 80 percent predicted/personal best	<60 percent predicted/personal best
	Validated questionnaires
	ATAQ	0	1 to 2	3 to 4
	ACQ	≤0.75*	≥1.5	N/A
	ACT	≥20	16 to 19	≤15
Risk	Exacerbations	0 to 1/year	≥2/year (see footnote)
	Exacerbations	Consider severity and interval since last exacerbation
	Progressive loss of lung function	Evaluation requires long-term follow-up care
	Treatment-related adverse effects	Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk.

The level of control is based on the most severe impairment or risk category. Assess impairment domain by patient's recall of previous two to four weeks and by spirometry/or peak flow measures. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient's asthma is better or worse since the last visit. At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma control. In general, more frequent and intense exacerbations (eg, requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate poorer disease control. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have not-well-controlled asthma, even in the absence of impairment levels consistent with not-well-controlled asthma.

EIB: exercise-induced bronchospasm; FEV₁: forced expiratory volume in 1 second; ATAQ: Asthma Therapy Assessment Questionnaire (Vollmer et al. 1999); ACQ: Asthma Control Questionnaire (Juniper et al. 1999b); ACT: Asthma Control Test (Nathan et al. 2004); N/A: not applicable.
* ACQ values of 0.76 to 1.4 are indeterminate regarding well-controlled asthma.

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.

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