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Classify Asthma Severity

Assessing severity and initiating treatment for patients who are not currently taking long-term control medications

ErstellerThe National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)
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Introduction

The National Asthma Education and Prevention Program (NAEPP) was initiated in 1989 to address the growing national health problem of asthma, which remains a significant problem today. The National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) provides a venue for convening diverse stakeholders with an interest in improving asthma management in the context of current standards of care. The NAEPPCC first developed and widely disseminated the guidelines for diagnosing and managing asthma in 1991, followed by revisions in 1997, 2002, 2007, and 2020. The most recent update to these guidelines, the 2020 Focused Updates to the Asthma Management Guidelines, provides guidance on six selected topic areas.

The NAEPP’s former National Asthma Control Initiative (NACI) engaged diverse stakeholders to bring asthma care in line with evidence-based recommendations. NAEPP and NACI resources for patients with asthma and their families and for health professionals are still available.

The NAEPPCC consists of representatives from the major scientific, professional, governmental, and voluntary organizations interested in asthma. The Committee’s primary mission is to advise the NHLBI on matters concerning asthma and to facilitate the exchange of information on asthma activities among the member agencies and voluntary health organizations.

The NHLBI administers and coordinates the NAEPPCC. These NAEPPPCC’s meetings are open to the public and include presentations and discussions on a variety of topics concerning asthma, including activities and projects of the Committee. View details about NAEPPCC meetings and materials.

The Classify Asthma Severity tool can be used for: 

  • patients not currently treated for asthma or 

  • the patient's treatment plan is unknown or 

  • the patient is not taking asthma controller medications as prescribed for at least three months. 

Recommendations

The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma details how to assess asthma severity and determine the appropriate treatment step during the initial visit of a newly diagnosed asthma patient. 

The Classify Asthma Severity tool can be used for: 

  • patients not currently treated for asthma or 

  • the patient's treatment plan is unknown or 

  • the patient is not taking asthma controller medications as prescribed for at least three months. 

 

Assessing asthma severity and initiating therapy is based on the most severe impairment or risk category. 

  • Classification of Asthma Severity (≥12 years of age and older)

  • Classification of Asthma Severity (5-11 years of age)

  • Classification of Asthma Severity (0-4 years of age)

 

The new EPR-4 Asthma Treatment Guidelines stipulate that patients age 4 years old will follow treatment recommendations for ages 5-11 years old for steps 3 & 4. This decision tool will incorporate the new EPR-4 recommendations by including recommendations for ages 4-11 that involve step 3 and 4.

Alle Fragen und möglichen Ergebnisse

AgeTitel nicht sichtbar
Choose age group

Select one option:

  • 0-3 years old
  • 4 years old
  • 5-11 years old
  • 12+ years old
Assess Pre-exacerbation Severity (Ages12+)

These are pre-exacerbation questions that are meant to determine how the patient was doing before the exacerbation event.

Daytime symptoms

Select one option:

  • throughout the day
  • daily
  • > 2 days/week, not daily
  • ≤ 2 days/week
Nighttime symptoms

Select one option:

  • often 7x week
  • > 1x/week but not nightly
  • 3-4x/month
  • ≤ 2x/month
Exacerbations requiring oral steroids

Select one option:

  • ≥ 2 per year
  • 0-1/year
Short-acting beta agonist (SABA) for symptom control (not exercise induced)

Select one option:

  • several times a day
  • daily
  • > 2 days/week but not daily, and not more than 1x on any day
  • ≤ 2 days a week
Interference with normal activity

Select one option:

  • extremely limited
  • some limitation
  • minor limitation
  • none
Select Lung Function (optional)

Intermittent

Mild Persistent

Moderate Persistent

Severe Persistent

  • Normal FEV₁ between exacerbations

  • FEV₁ >80% predicted

  • FEV₁/FVC normal*

  • FEV₁ ≥80% predicted

  • FEV₁/FVC normal*

  • FEV₁ >60% but <80% predicted

  • FEV₁/FVC reduced 5%

  • FEV₁ <60% predicted

  • FEV₁/FVC reduced 5%

*Normal FEV₁/FVC

8-19 yr       85%

20-39 yr     80%

40-59 yr     75%

60-80 yr     70%

 

Select one option:

  • Severe Persistent
  • Moderate Persistent
  • Mild Persistent
  • Intermittent
  • Unknown
Assess Pre-exacerbation Severity (Ages 5-11)

These are pre-exacerbation questions that are meant to determine how the patient was doing before the exacerbation event.

Daytime symptoms

Select one option:

  • throughout the day
  • daily
  • > 2 days/week, not daily
  • ≤ 2 days/week
Nighttime symptoms

Select one option:

  • Often 7x/week
  • > 1x/week but not nightly
  • 3-4x/month
  • ≤ 2x/month
Exacerbations requiring oral steroids

Select one option:

  • ≥ 2 per year
  • 0-1/year
Short-acting beta agonist (SABA) for symptom control (not exercise induced)

Select one option:

  • several times a day
  • daily
  • > 2 days/week but not daily, and not more than 1x on any day
  • ≤ 2 days a week
Interference with normal activity

Select one option:

  • extremely limited
  • some limitation
  • minor limitation
  • none
Select Lung function (optional)
IntermittentMild PersistentModerate PersistentSevere Persistent
  • Normal FEV₁ between exacerbations
  • FEV₁ >80% predicted
  • FEV₁/FVC >85%
  • FEV₁ ≥80% predicted
  • FEV₁/FVC  >80%
  • FEV₁ >60% but <80% predicted
  • FEV₁/FVC 75-80%
  • FEV₁ <60% predicted
  • FEV₁/FVC <75%

 

 

Select one option:

  • Severe Persistent
  • Moderate Persistent
  • Mild Persistent
  • Intermittent
  • Unknown
Assess Pre-exacerbation Severity (Ages 0-4)

These are pre-exacerbation questions that are meant to determine how the patient was doing before the exacerbation event.

Daytime symptoms

Select one option:

  • throughout the day
  • daily
  • > 2 days/week, not daily
  • ≤ 2 days/week
Nighttime symptoms

Select one option:

  • > 1x/week
  • 3-4x/month
  • 1-2x/month
  • 0
Short-acting beta-agonist use for symptom control (not exercise induced)

Select one option:

  • several times per day
  • daily
  • > 2 days/week but not daily
  • ≤ 2 days/week
Interference with normal activity

Select one option:

  • Extremely limited
  • some limitation
  • minor limitation
  • none
Exacerbations requiring oral steroids

Select one option:

  • ≥ 2 exacerbations in 6 months requiring oral systemic corticosteroids, or ≥ 4 wheezing episodes/1 year lasting > 1 day AND risk factors for persistent asthma
  • 0-1/year
Mögliche Ergebnisse
Intermittent (Ages 5-11): Initiate treatment at Step 1. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Moderate Persistent: Ages 5-11)
Severe Persistent (Ages 5-11): Initiate step 3 or step 4. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

  • Note: The EPR-4 guidelines now recommend SMART Therapy (Step 3) as the preferred treatment over the EPR-3 medium-dose ICS option (now considered an alternative therapy in step 3 EPR-4 guidelines).

EPR-4 Step Therapy Guideline Summary

 

Severe Persistent (Ages 0-4): Initiate treatment at Step 3. In 2-6 weeks, evaluate level of asthma control and adjust therapy accordingly. If no clear benefit in 4-6 weeks, consider adjusting therapy or alternative diagnosis.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary (Ages 0-4)

EPR-4 Step Therapy Guideline Summary (Ages 5-11)

  • Note: Age 4 will follow therapy guidelines for ages 5-11 for step 3 & 4.

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Severe Persistent: Ages 0-4)
Moderate Persistent (Ages 12+): Initiate treatment at Step 3. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Moderate Persistent: Ages 12+)
Mild Persistent (Ages 0-4): Initiate treatment at Step 2. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly. If no clear benefit in 4-6 weeks, consider adjusting therapy or alternative diagnosis.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary (Ages 0-4)

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Severe Persistent: Ages 5-11)
Intermittent (Ages 0-4): Initiate treatment at Step 1. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly. If no clear benefit in 4-6 weeks, consider adjusting therapy or alternative diagnosis.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary (Ages 0-4)

 

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Severe Persistent: Ages 12+)
Severe Persistent (Ages 12+): Initiate treatment at step 4 or 5. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

Due to severity, consider short course of oral corticosteroids: 30-60 mg/day, as a single or 2 divided doses max 60 mg/day. Treat for 3-10 days. (Moderate Persistent: Ages 0-4)
Mild Persistent (Ages 5-11): Initiate treatment at Step 2. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

Moderate Persistent (Ages 0-4): Initiate treatment at Step 3. In 2-6 weeks, evaluate level of asthma control and adjust therapy accordingly. If no clear benefit in 4-6 weeks, consider adjusting therapy or alternative diagnosis.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary (Ages 0-4)

EPR-4 Step Therapy Guideline Summary (Ages 5-11)

  • Note: Age 4 will follow therapy guidelines for ages 5-11 for step 3 & 4.

Mild Persistent (Ages 12+): Initiate treatment at Step 2. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

 

Intermittent (Ages 12+): Initiate treatment at Step 1. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

EPR-4 Step Therapy Guideline Summary

Moderate Persistent (Ages 5-11): Initiate treatment at Step 3. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.

EPR-3 Assess Severity Guideline Summary

  • Note: The EPR-4 guidelines now recommend SMART Therapy (Step 3) as the preferred treatment over the EPR-3 medium-dose ICS option (now considered an alternative therapy in step 3 EPR-4 guidelines).

EPR-4 Step Therapy Guideline Summary

 

Zitat

National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC)

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