Classify Asthma Severity
Assessing severity and initiating treatment for patients who are not currently taking long-term control medications
Jennifer Glen, Tim Michalski
Provided by
EVAL FoundationUsage
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.
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Summary
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)
See Figure 4-6
Classification of Asthma Severity (5-11 years of age)
See Figure 3-4b
Classification of Asthma Severity (0-4 years of age)
See Figure 4-2a
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.
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All questions & possible results
AgeTitle not visible
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 |
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*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)
| Intermittent | Mild Persistent | Moderate Persistent | Severe Persistent |
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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
Possible results
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.
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.
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.
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.
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.
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.
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.
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.
Intermittent (Ages 12+): Initiate treatment at Step 1. In 2-6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.
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
Literature
- Guidelines for the Diagnosis and Management of Asthma- Summary Report 2007 — National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3)
- 2020 Focused Updates to the Asthma Management Guidelines — National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
