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% 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.
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