Asthma classification: Difference between revisions
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==Overview== | ==Overview== | ||
Asthma is classified into four subgroup, namely, mild intermittent, mild persistent, moderate persistent and severe persistent based on the '''GINA severity | 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> | ||
==Mild Intermittent Asthma== | ==Mild Intermittent Asthma<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>== | ||
{| border="1" align="center" style="background:lightskyblue" | {| border="1" align="center" style="background:lightskyblue" | ||
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| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability''' | | bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability''' | ||
|- | |- | ||
| style="text-align:center" | | | style="text-align:center" | Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations. | ||
| style="text-align:center" | | | style="text-align:center" | Less than or equal to twice a month | ||
| style="text-align:center" | ≥ 80% | | style="text-align:center" | ≥ 80% | ||
| style="text-align:center" | < 20% | | style="text-align:center" | < 20% | ||
|} | |} | ||
'''Treatment:''' Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis. | |||
== | ==Mild Persistent Asthma<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>== | ||
==Severe Persistent Asthma== | {| border="1" align="center" style="background:lightskyblue" | ||
|- | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per day''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability''' | |||
|- | |||
| style="text-align:center" | Symptoms more than twice a week but less than once a day. Exacerbations may affect activity and sleep. | |||
| style="text-align:center" | greater than or equal to twice a month | |||
| style="text-align:center" | ≥ 80% | |||
| style="text-align:center" | 20-30% | |||
|} | |||
'''Treatment:''' | |||
*Anti-inflammatory drugs such as [[cromolyn]] or [[nedocromil]] or once a day [[steroid|low-dose steroid]] inhalation. | |||
*[[Theophylline]], [[montelukast]], [[zafirlukast]] may be considered as an alternative along with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]]. | |||
==Moderate Persistent Asthma<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>== | |||
{| border="1" align="center" style="background:lightskyblue" | |||
|- | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per day''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability''' | |||
|- | |||
| style="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="text-align:center" | more than once a month | |||
| style="text-align:center" | 60-80% | |||
| style="text-align:center" | ≥ 30% | |||
|} | |||
'''Treatment:''' | |||
*Moderate dose of inhaled [[steroid]], ''OR'' | |||
*Low dose inhaled [[steroid]] along with inhaled [[Bronchodilators#Long-acting β2-agonists|long-acting β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] for nocturnal symptoms, ''OR'' | |||
*Moderate doses of inhaled [[steroid]] along with long-acting bronchodilators (such as [[Bronchodilators#Long-acting β2-agonists|inhaled 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<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>== | |||
{| border="1" align="center" style="background:lightskyblue" | |||
|- | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per day''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1''' | |||
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability''' | |||
|- | |||
| style="text-align:center" | Continued symptoms. Frequent exacerbations. Limited physical activity. | |||
| style="text-align:center" | Frequent | |||
| style="text-align:center" | ≤ 60% | |||
| style="text-align:center" | ≥ 30% | |||
|} | |||
'''Treatment:''' | |||
*High-dose of inhaled [[steroid]] 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). | |||
*Oral [[steroids]] and/or short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] may be used on need basis. | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Up-To-Date]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 14:25, 26 September 2011
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Asthma Microchapters |
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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[1]
| 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% | < 20% |
Treatment: Short-acting inhaled β2-agonists on need basis.
Mild Persistent Asthma[1]
| 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% |
Treatment:
- Anti-inflammatory drugs such as cromolyn or nedocromil or once a day low-dose steroid inhalation.
- Theophylline, montelukast, zafirlukast may be considered as an alternative along with a short-acting inhaled β2-agonists.
Moderate Persistent Asthma[1]
| 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% |
Treatment:
- Moderate dose of inhaled steroid, OR
- Low dose inhaled steroid along with inhaled long-acting β2-agonists or sustained-release theophylline for nocturnal symptoms, OR
- Moderate doses of inhaled steroid along with long-acting bronchodilators (such as inhaled β2-agonists or sustained-release theophylline) and/or a short-acting inhaled β2-agonists on need basis.
Severe Persistent Asthma[1]
| Symptoms per day | Symptoms per night | PEF or FEV1 | PEF variability |
| Continued symptoms. Frequent exacerbations. Limited physical activity. | Frequent | ≤ 60% | ≥ 30% |
Treatment:
- High-dose of inhaled steroid along with long-acting bronchodilators (such as inhaled β2-agonists or sustained-release theophylline used alone or in combination).
- Oral steroids and/or short-acting inhaled β2-agonists may be used on need basis.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 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