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| style="text-align:center" | Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations. | | style="text-align:center" | Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations. | ||
| style="text-align:center" | Less than or equal to twice a month | | style="text-align:center" | Less than or equal to twice a month | ||
| style="text-align:center" | ≥ 80% | | style="text-align:center" | ≥ 80% of predicted normal | ||
| style="text-align:center" | < 20% | | style="text-align:center" | < 20% | ||
|} | |} | ||
==== | ====Step 1 therapy:==== | ||
Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis. | 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> | ||
==Mild Persistent Asthma== | ==Mild Persistent Asthma== | ||
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==== | ====Step 2 therapy:==== | ||
* | *Preferred drug of choice is once a day [[steroid|low-dose steroid]] inhalation. | ||
*[[Theophylline]], [[montelukast]], [[zafirlukast]] | *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== | ==Moderate Persistent Asthma== | ||
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==== | ====Step 3 therapy:==== | ||
*Moderate dose of inhaled [[steroid]], ''OR'' | *Preferred drug of choice: | ||
*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, | :*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== | ==Severe Persistent Asthma== | ||
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==== | ====Step 4 or Step 5 Therapy==== | ||
* | '''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. | |||
''OR'' | |||
'''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)[http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf]== | |||
==References== | ==References== | ||
Revision as of 14:58, 27 September 2011
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Asthma Microchapters |
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Other Diagnostic Studies |
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Treatment |
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Case Studies |
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Asthma classification On the Web |
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American Roentgen Ray Society Images of 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 four subgroup, namely, 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 per 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% |
Step 1 therapy:
Short-acting inhaled β2-agonists on need basis.[2][3]
Mild Persistent Asthma
| Symptoms per day | Symptoms per 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% |
Step 2 therapy:
- Preferred drug of choice is once a day low-dose steroid inhalation.
- Alternative therapies include:
- Use of anti-inflammatory drugs such as cromolyn or nedocromil, OR
- Theophylline, montelukast, zafirlukast along with a short-acting inhaled β2-agonists.[4]
Moderate Persistent Asthma
| Symptoms per day | Symptoms per 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% |
Step 3 therapy:
- Preferred drug of choice:
- Moderate dose of inhaled steroid, OR
- Low dose inhaled steroid along with inhaled long-acting β2-agonists [5] or sustained-release theophylline for nocturnal symptoms,
- Alternative strategy includes the use of low-dose of inhaled steroid along with long-acting bronchodilators (either inhaled long-acting β2-agonists or sustained-release theophylline) and/or a short-acting inhaled β2-agonists on need basis.
Severe Persistent Asthma
| Symptoms per day | Symptoms per night | PEF or FEV1 | PEF variability |
| Continued symptoms. Frequent exacerbations. Limited physical activity. | Frequent | ≤ 60% | ≥ 30% |
Step 4 or Step 5 Therapy
Step 4 therapy:
- Preferred drug of choice: Medium-dose of inhaled steroid along with inhaled long-acting β2-agonists
- Alternative strategy includes the use of medium-dose inhaled steroids along with long-acting bronchodilators (such as inhaled β2-agonists or sustained-release theophylline used alone or in combination) and/or short-acting inhaled β2-agonists may be used on need basis.
OR
Step 5 therapy:
- Preferred drug of choice: High-dose of inhaled steroid along with 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)[3]
References
- ↑ 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
- ↑ Shim C, Williams MH (1980) Bronchial response to oral versus aerosol metaproterenol in asthma. Ann Intern Med 93 (3):428-31. PMID: 7436160
- ↑ Shim C, Williams MH (1981) Comparison of oral aminophylline and aerosol metaproterenol in asthma. Am J Med 71 (3):452-5. PMID: 7282733
- ↑ Berridge MS, Lee Z, Heald DL (2000) Pulmonary distribution and kinetics of inhaled [11Ctriamcinolone acetonide.] J Nucl Med 41 (10):1603-11. PMID: 11037987
- ↑ Nelson HS (2001) Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma. J Allergy Clin Immunol 107 (2):398-416. DOI:10.1067/mai.2001.112939 PMID: 11174215