Components of severity | Classification of asthma severity (0 to 4 years of age) |
Intermittent | Persistent |
Mild | Moderate | Severe |
Impairment | Symptoms | ≤2 days/week | >2 days/week but not daily | Daily | Throughout the day |
Nighttime awakenings | 0 | 1 to 2 times/month | 3 to 4 times/month | >1 time/week |
Short-acting beta2 agonist use for symptom control (not prevention of EIB) | ≤2 days/week | >2 days/week but not daily | Daily | Several times per day |
Interference with normal activity | None | Minor limitation | Some limitation | Extremely limited |
Risk | Exacerbations requiring oral systemic glucocorticoids | 0 to 1/year | ≥2 exacerbations in 6 months requiring oral systemic glucocorticoids, or ≥4 wheezing episodes/one year lasting >1 day AND risk factors for persistent asthma |
Consider severity and interval since last exacerbation |
Frequency and severity may fluctuate over time |
Exacerbations of any severity may occur in patients in any severity category |
Recommended step for initiating treatment | Step 1 | Step 2 | Step 3 and consider short course of oral systemic glucocorticoids |
In 2 to 6 weeks, depending on severity, evaluate level of asthma control that is achieved. If no clear benefit is observed in 4 to 6 weeks, consider adjusting therapy or alternative diagnoses. |