Asthma classification
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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% | < 20% |
Treatment: 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% |
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
| 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
| 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
- ↑ 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