Asthma classification

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 four subgroup, namely, mild intermittent, mild persistent, moderate persistent and severe persistent based on the Global Initiative for Asthma - GINA severity grades.

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.

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.

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 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]