Asthma classification: Difference between revisions

Jump to navigation Jump to search
← Older edit
VisualWikitext
Sergekorjian (talk | contribs)
CMEUser, Bots, Bureaucrats, bureaucrats, editnews, interwiki, nocaptcha, nukepages, oversight, smwadministrator, Administrators, Widget editors
5,932 edits
/* Guidelines for Diagnosis and Management of Asthma Based On The National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR3) Urbano FL (2008) Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines....
WikiBot (talk | contribs)
Bots, Bureaucrats, bureaucrats, interwiki, nocaptcha, Administrators
57,550 edits
m Bot: Removing from Primary care
 
(33 intermediate revisions by 2 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
Asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.
Asthma is classified into [[atopic]] and non-atopic types based on the onset of [[symptoms]]. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.


==Classification==
==Classification==
Line 23: Line 23:


===Based on GINA Severity Grade===
===Based on GINA Severity Grade===
Asthma is classified into four subgroup, namely, mild intermittent, mild persistent, moderate persistent and severe persistent based on the ''Global Initiative for Asthma - GINA severity grades''.<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78. [http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID: [http://pubmed.gov/18166595 18166595]</ref>
Asthma is classified into four subgroups: mild intermittent, mild persistent, moderate persistent and severe persistent based on the ''Global Initiative for Asthma - GINA severity grades''.<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78. [http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID: [http://pubmed.gov/18166595 18166595]</ref>


===Mild Intermittent Asthma===
====Mild Intermittent Asthma====
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
{| align="center" style="border: 0px; font-size: 90%; margin: 3px; width:70%;"
|-
|-
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 55%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per night'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms at night'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations.
| style="background: #DCDCDC; padding: 5px; text-align: left;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less than or equal to twice a month
*Less than once a week  
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 80% of predicted normal
*Brief exacerbations
| style="background: #DCDCDC; padding: 5px; text-align: center;" | < 20%
*Asymptomatic and normal PEFR between exacerbations
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Less than or equal to twice a month
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 80% of predicted normal
| style="background: #DCDCDC; padding: 5px; text-align: center;" | < 20%
|}
|}


====Step 1 Therapy:====
====Mild Persistent Asthma====
Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis.<ref name="pmid7436160">Shim C, Williams MH (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7436160 Bronchial response to oral versus aerosol metaproterenol in asthma.] ''Ann Intern Med'' 93 (3):428-31. PMID: [http://pubmed.gov/7436160 7436160]</ref><ref name="pmid7282733">Shim C, Williams MH (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7282733 Comparison of oral aminophylline and aerosol metaproterenol in asthma.] ''Am J Med'' 71 (3):452-5. PMID: [http://pubmed.gov/7282733 7282733]</ref>
{| align="center" style="border: 0px; font-size: 90%; margin: 3px; width:70%;"
 
===Mild Persistent Asthma===
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
|-
|-
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 55%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per night'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms at night'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Symptoms more than twice a week but less than once a day. Exacerbations may affect activity and sleep.  
| style="background: #DCDCDC; padding: 5px; text-align: left;" |  
*Symptoms more than twice a week but less than once a day
*Exacerbations may affect activity and sleep.  
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Greater than or equal to twice a month
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Greater than or equal to twice a month
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 80%
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 80%
Line 56: Line 58:
|}
|}


====Step 2 Therapy:====
====Moderate Persistent Asthma====
*Preferred drug of choice is once a day [[steroid|low-dose steroid]] inhalation.
{| align="center" style="border: 0px; font-size: 90%; margin: 3px; width:70%;"  
*Alternative therapies include:
:*Use of anti-inflammatory drugs such as [[cromolyn]] or [[nedocromil]], ''OR''
:*[[Theophylline]], [[montelukast]], [[zafirlukast]] along with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]].<ref name="pmid11037987">Berridge MS, Lee Z, Heald DL (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11037987 Pulmonary distribution and kinetics of inhaled [11C]triamcinolone acetonide.] ''J Nucl Med'' 41 (10):1603-11. PMID: [http://pubmed.gov/11037987 11037987]</ref>
 
===Moderate Persistent Asthma===
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"  
|-
|-
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 55%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per night'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms at night'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Daily symptoms. Exacerbations more than twice a week. Exacerbations may affect activity and sleep. Daily use of [[Bronchodilators#Short-acting β2-agonists|bronchodilators]].    
| style="background: #DCDCDC; padding: 5px; text-align: left;" |  
*Daily symptoms
*Exacerbations more than twice a week
*Exacerbations may affect activity and sleep
*Daily use of [[Bronchodilators#Short-acting β2-agonists|bronchodilators]]   
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More than once a month
| style="background: #DCDCDC; padding: 5px; text-align: center;" | More than once a month
| style="background: #DCDCDC; padding: 5px; text-align: center;" | 60-80%
| style="background: #DCDCDC; padding: 5px; text-align: center;" | 60-80%
Line 76: Line 76:
|}
|}


====Step 3 Therapy:====
====Severe Persistent Asthma====
*Preferred drug of choice:
{| align="center" style="border: 0px; font-size: 90%; margin: 3px; width:70%;"  
:*Moderate dose of inhaled [[steroid]], ''OR''
:*Low dose inhaled [[steroid]] along with inhaled [[Bronchodilators#Long-acting β2-agonists|long-acting β2-agonists]] <ref name="pmid11174215">Nelson HS (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11174215 Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma.] ''J Allergy Clin Immunol'' 107 (2):398-416. [http://dx.doi.org/10.1067/mai.2001.112939 DOI:10.1067/mai.2001.112939] PMID: [http://pubmed.gov/11174215 11174215]</ref> or [[Bronchodilators#Theophylline|sustained-release theophylline]] for nocturnal symptoms,
*Alternative strategy includes the use of low-dose of inhaled [[steroid]] along with long-acting bronchodilators (either [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]]) and/or a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis.
 
===Severe Persistent Asthma===
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"  
|-
|-
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 55%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per day'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms per night'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Symptoms at night'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF or FEV1'''}}
| style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
| style="width: 15%; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''PEF variability'''}}
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Continued symptoms. Frequent exacerbations. Limited physical activity.  
| style="background: #DCDCDC; padding: 5px; text-align: left;" |  
*Continued symptoms
*Frequent exacerbations
*Limited physical activity   
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Frequent
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Frequent
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≤ 60%
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≤ 60%
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 30%
| style="background: #DCDCDC; padding: 5px; text-align: center;" | ≥ 30%
|}
|}
====Step 4 Therapy:====
*Preferred drug of choice: Medium-dose of inhaled [[steroid]] along with  [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]]
*Alternative strategy includes the use of medium-dose inhaled [[steroids]] along with long-acting [[bronchodilators]] (such as [[Bronchodilators#Long-acting β2-agonists|inhaled β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] used alone or in combination) and/or short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] may be used on need basis.
====Step 5 Therapy:====
*Preferred drug of choice: High-dose of inhaled [[steroid]] along with  [[Bronchodilators#Long-acting β2-agonists|inhaled long-acting β2-agonists]] and [[omalizumab]] in patients who have allergies.


==Guidelines for Diagnosis and Management of Asthma Based On The National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR3) <ref name="pmid18240881">Urbano FL (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18240881 Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines.] ''J Manag Care Pharm'' 14 (1):41-9. PMID: [http://pubmed.gov/18240881 18240881]</ref>==
==Guidelines for Diagnosis and Management of Asthma Based On The National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR3) <ref name="pmid18240881">Urbano FL (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18240881 Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines.] ''J Manag Care Pharm'' 14 (1):41-9. PMID: [http://pubmed.gov/18240881 18240881]</ref>==


{| class="wikitable"
{| style="border: 0px; font-size: 90%; margin: 3px;"  
! rowspan="2" style="text-align: center;" | Severity Components
! rowspan="2" style="text-align: center; background: #4479BA; text-align: center; width: 12%;" | {{fontcolor|#FFF|Severity Components}}
! style="text-align: center;" | Intermittent
! rowspan="2" style="text-align: center; background: #4479BA; text-align: center; width: 22%;" | {{fontcolor|#FFF|Intermittent}}
! colspan="3" style="text-align: center;" | Persistent Asthma
! colspan="3" style="text-align: center; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Persistent Asthma}}
|-
|-
| style="text-align: center;" |
| style="text-align: center; background: #7d7d7d; text-align: center; width: 22%;" | {{fontcolor|#FFF|'''Mild'''}}
| style="text-align: center;" | Mild
| style="text-align: center; background: #7d7d7d; text-align: center; width: 22%;" | {{fontcolor|#FFF|'''Moderate'''}}
| style="text-align: center;" | Moderate
| style="text-align: center; background: #7d7d7d; text-align: center; width: 22%;" | {{fontcolor|#FFF|'''Severe'''}}
| style="text-align: center;" | Severe
|-
|-
| Symptoms
| style="background: #DCDCDC; padding: 5px;" |'''Symptoms'''
| Less than 1 day/week
| style="background: #F5F5F5; padding: 5px;" |
| More than 2 days/week
* Less than 1 day/week
Not daily
| style="background: #F5F5F5; padding: 5px;" |
| Daily
* More than 2 days/week
| Daily
* Not daily
Throughout the day
| style="background: #F5F5F5; padding: 5px;" |
* Daily
| style="background: #F5F5F5; padding: 5px;" |
* Daily
* Throughout the day
|-
|-
| Nocturnal Symptoms
| style="background: #DCDCDC; padding: 5px;" |'''Nocturnal Symptoms'''
| Less than 2 times/month
| style="background: #F5F5F5; padding: 5px;" |
| 3 to 4 times/month
* Less than 2 times/month
| More than 1 time/week
| style="background: #F5F5F5; padding: 5px;" |
Not every night
* 3 to 4 times/month
| Every night
| style="background: #F5F5F5; padding: 5px;" |
* More than 1 time/week
* Not every night
| style="background: #F5F5F5; padding: 5px;" |
* Every night
|-
|-
| Interference w/ Activity
| style="background: #DCDCDC; padding: 5px;" |'''Interference w/ Activity'''
| Minimal to none
| style="background: #F5F5F5; padding: 5px;" |
| Minor limitation of activity
* Minimal to none
| Some limitation of activity
| style="background: #F5F5F5; padding: 5px;" |
| Severe limitation of activity
* Minor limitation of activity
| style="background: #F5F5F5; padding: 5px;" |
* Some limitation of activity
| style="background: #F5F5F5; padding: 5px;" |
* Severe limitation of activity
|-
|-
| Short Acting Beta-Agonist Use
| style="background: #DCDCDC; padding: 5px;" |'''Short-Acting Beta-Agonist Use'''
| Less than 2 days/week
| style="background: #F5F5F5; padding: 5px;" |
| More than 2 days/week but not daily
* Less than 2 days/week
Not more than once/day
| style="background: #F5F5F5; padding: 5px;" |
| Daily
* More than 2 days/week but not daily
| Several times/day
* Not more than once/day
| style="background: #F5F5F5; padding: 5px;" |
* Daily
| style="background: #F5F5F5; padding: 5px;" |
* Several times/day
|-
|-
| Pulmonary Funtion Test
| style="background: #DCDCDC; padding: 5px;" |'''Pulmonary Function Test'''
| Normal FEV1 between exacerbations
| style="background: #F5F5F5; padding: 5px;" |
FEV1 > 80% predicted
* Normal FEV<sub>1</sub> between exacerbations
FEV1/FVC normal
* FEV<sub>1</sub> > 80% predicted
| FEV1 > 80% predicted
* FEV<sub>1</sub>/FVC normal
FEV1/FVC normal
| style="background: #F5F5F5; padding: 5px;" |
| FEV1 > 60% but < 80% predicted
* FEV<sub>1</sub> > 80% predicted
FEV1/FVC reduced by 5%
* FEV<sub>1</sub>/FVC normal
| FEV1 < 60% predicted
| style="background: #F5F5F5; padding: 5px;" |
FEV1/FVC reduced by > 5%
* FEV<sub>1</sub> > 60% but < 80% predicted
* FEV<sub>1</sub>/FVC reduced by 5%
| style="background: #F5F5F5; padding: 5px;" |
* FEV<sub>1</sub> < 60% predicted
* FEV<sub>1</sub>/FVC reduced by > 5%
|-
|-
| Recommended Treatment Strategy
| style="background: #DCDCDC; padding: 5px;" |'''Recommended Treatment Strategy'''
| STEP 1
| style="background: #F5F5F5; padding: 5px; vertical-align:top;" |'''STEP 1'''
Preferred: Short-acting beta-agonist PRN
* ''Preferred:'' Short-acting beta-agonist PRN
| STEP 2
| style="background: #F5F5F5; padding: 5px; vertical-align:top;" |'''STEP 2'''
Preferred: Low-dose inhaled corticosteroids
* ''Preferred:'' Low-dose inhaled corticosteroids
Alternative: Cromolyn, Leukotriene receptor antagonist, Nedocromil, or Theophylline
* ''Alternative:'' Cromolyn, Leukotriene receptor antagonist, Nedocromil, or Theophylline
| STEP 3
| style="background: #F5F5F5; padding: 5px; vertical-align:top;" |'''STEP 3'''
Preferred: Low-dose inhaled corticosteroids + Long-acting beta-agonist
* ''Preferred:'' '''Either''' low-dose inhaled corticosteroids + long-acting beta-agonist '''OR''' Medium-dose inhaled corticosteroid
OR
Medium-dose inhaled corticosteroid
 
Alternative: Low-dose inhaled corticosteroid + either Leukotriene receptor antagonist, Theophylline, or Zileuton
| STEP 4
 


STEP 5
* ''Alternative:'' Low-dose inhaled corticosteroid + either Leukotriene receptor antagonist, Theophylline, or Zileuton
| style="background: #F5F5F5; padding: 5px;" |'''STEP 4'''
* ''Preferred:'' Medium-dose inhaled corticosteroid + long-acting beta-agonist
* ''Alternative:'' Medium-dose inhaled corticosteroids + either Leukotriene receptor antagonist, Theophylline, or Zileuton


'''STEP 5'''
* ''Preferred:'' High-dose inhaled corticosteroids + long-acting beta-agonist
* Consider adding Omalizumab for patients with allergies


STEP 6
'''STEP 6'''
* ''Preferred:'' High-dose inhaled corticosteroids + long-acting beta-agonist + oral corticosteroids
* Consider adding Omalizumab for patients with allergies
|-
|-
| colspan="5" style="text-align: center;" | Step down if possible and asthma is controlled for at least 3 months                                                                                             Step-up if needed
| colspan="5" style="text-align: center; background: #4479BA; padding: 5px;" | {{fontcolor|#FFF|'''Step down if possible and asthma is controlled for at least 3 months'''}} [[File:Dualarrow.png|200px]] {{fontcolor|#FFF|'''Step-up if needed, but first check adherence, environmental control, and comorbidities'''}}
|-
|-
| colspan="5" | In each step, patient education, environmental control, and management of comorbidities are important.
| colspan="5" style="background: #F5F5F5; padding: 5px;" |
In STEP 2 - 4, consider subcutaneous allergen immunotherapy for patients with allergic asthma
* In each step, patient education, environmental control, and management of comorbidities are important.
* In STEP 2 - 4, consider subcutaneous allergen immunotherapy for patients with allergic asthma
|-
|-
| colspan="5" | Short-acting beta agonist as needed for symptoms. Up to 3 treatments at 20 minute intervals as needed.
| colspan="5" style="background: #F5F5F5; padding: 5px;" |
A short course of oral systemic corticosteroids may be needed.
* Short-acting beta-agonist as needed for symptoms. Up to 3 treatments at 20 minute intervals as needed.
Use of a short-acting beta agonist for >2 days a week for symptom control indicates inadequate control and the need to step up therapy.
* A short course of oral systemic corticosteroids may be needed. Use of a short-acting beta agonist for >2 days a week for symptom control indicates inadequate control and the need to step up therapy.
|}
|}
<br clear="left"/>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Overview complete]]
[[Category:Template complete]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Immunology]]
[[Category:Immunology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Allergology]]
[[Category:Asthma]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date pulmonology]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
{{WH}}
{{WS}}

Latest revision as of 20:30, 29 July 2020

Asthma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Asthma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Pulmonary Function Test
Bronchial Challenge Test
Exhaled nitric oxide

Treatment

Emergency Management

Medical Therapy

Alternative and Complementary Medicine

Bronchial Thermoplasty

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Asthma classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Asthma classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Asthma classification

CDC on Asthma classification

Asthma classification in the news

Blogs on Asthma classification

Directions to Hospitals Treating Asthma

Risk calculators and risk factors for Asthma classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.

Classification

Based on Symptom Onset

Early-onset Asthma (Atopic, Allergic, Extrinsic)

Late-onset Asthma (Non-Atopic, Idiosyncratic, Intrinsic)

Based on GINA Severity Grade

Asthma is classified into four subgroups: mild intermittent, mild persistent, moderate persistent and severe persistent based on the Global Initiative for Asthma - GINA severity grades.[1]

Mild Intermittent Asthma

Symptoms per day Symptoms at night PEF or FEV1 PEF variability
  • Less than once a week
  • Brief exacerbations
  • Asymptomatic and normal PEFR between exacerbations
 Less than or equal to twice a month ≥ 80% of predicted normal < 20%

Mild Persistent Asthma

Symptoms per day Symptoms at night PEF or FEV1 PEF variability
  • Symptoms more than twice a week but less than once a day
  • Exacerbations may affect activity and sleep.
 Greater than or equal to twice a month ≥ 80% 20-30%

Moderate Persistent Asthma

Symptoms per day Symptoms at night PEF or FEV1 PEF variability
  • Daily symptoms
  • Exacerbations more than twice a week
  • Exacerbations may affect activity and sleep
  • Daily use of bronchodilators
 More than once a month 60-80% ≥ 30%

Severe Persistent Asthma

Symptoms per day Symptoms at night PEF or FEV1 PEF variability
  • Continued symptoms
  • Frequent exacerbations
  • Limited physical activity
 Frequent ≤ 60% ≥ 30%

Guidelines for Diagnosis and Management of Asthma Based On The National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR3) [2]

Severity Components Intermittent Persistent Asthma
Mild Moderate Severe
Symptoms
  • Less than 1 day/week
  • More than 2 days/week
  • Not daily
  • Daily
  • Daily
  • Throughout the day
Nocturnal Symptoms
  • Less than 2 times/month
  • 3 to 4 times/month
  • More than 1 time/week
  • Not every night
  • Every night
Interference w/ Activity
  • Minimal to none
  • Minor limitation of activity
  • Some limitation of activity
  • Severe limitation of activity
Short-Acting Beta-Agonist Use
  • Less than 2 days/week
  • More than 2 days/week but not daily
  • Not more than once/day
  • Daily
  • Several times/day
Pulmonary Function Test
  • Normal FEV1 between exacerbations
  • FEV1 > 80% predicted
  • FEV1/FVC normal
  • FEV1 > 80% predicted
  • FEV1/FVC normal
  • FEV1 > 60% but < 80% predicted
  • FEV1/FVC reduced by 5%
  • FEV1 < 60% predicted
  • FEV1/FVC reduced by > 5%
Recommended Treatment Strategy STEP 1
  • Preferred: Short-acting beta-agonist PRN
 STEP 2
  • Preferred: Low-dose inhaled corticosteroids
  • Alternative: Cromolyn, Leukotriene receptor antagonist, Nedocromil, or Theophylline
 STEP 3
  • Preferred: Either low-dose inhaled corticosteroids + long-acting beta-agonist OR Medium-dose inhaled corticosteroid
  • Alternative: Low-dose inhaled corticosteroid + either Leukotriene receptor antagonist, Theophylline, or Zileuton
 STEP 4
  • Preferred: Medium-dose inhaled corticosteroid + long-acting beta-agonist
  • Alternative: Medium-dose inhaled corticosteroids + either Leukotriene receptor antagonist, Theophylline, or Zileuton

STEP 5

  • Preferred: High-dose inhaled corticosteroids + long-acting beta-agonist
  • Consider adding Omalizumab for patients with allergies

STEP 6

  • Preferred: High-dose inhaled corticosteroids + long-acting beta-agonist + oral corticosteroids
  • Consider adding Omalizumab for patients with allergies
Step down if possible and asthma is controlled for at least 3 months Step-up if needed, but first check adherence, environmental control, and comorbidities
  • In each step, patient education, environmental control, and management of comorbidities are important.
  • In STEP 2 - 4, consider subcutaneous allergen immunotherapy for patients with allergic asthma
  • Short-acting beta-agonist as needed for symptoms. Up to 3 treatments at 20 minute intervals as needed.
  • A short course of oral systemic corticosteroids may be needed. Use of a short-acting beta agonist for >2 days a week for symptom control indicates inadequate control and the need to step up therapy.

References

  1. ↑ Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31 (1):143-78. DOI:10.1183/09031936.00138707 PMID: 18166595
  2. ↑ Urbano FL (2008) Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm 14 (1):41-9. PMID: 18240881

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Asthma_classification&oldid=1634926"