item1

Important Information and Facts about Asthma and the Natural History of Asthma

Predictors of Persistence and Severity of Childhood Asthma

  • Severe and frequent episodes of asthma during preschool age
  • Onset during school age
  • Family history of asthma and allergy
  • Elevated total serum IgE (blood test).
  • Early development of positive skin test results
  • Early development of bronchial hyperresponsiveness
  • Frequent respiratory infections
  • Lack of contact with older children
  • Parenting difficulties

Predictors of Persistence and Severity of Adult Asthma

  • Continued exposure to allergens including occupational agents
  • Older age of onset
  • Aspirin Hypersensitivity
  • Socioeconomic status
  • Smoking
  • Coexisting diseases, including COPD, bronchiectasis, allergic bronchopulmonary aspergillosis

Asthma Severity is best characterized by the use of the National Asthma Education and Prevention Program (NAEPP).
NAEPP Severity Level Classifications

 

NAEPP Severity Level Classifications

Clinical features before treatment*

 

Symptoms**

Nighttime symptoms

Lung function

Step1

Mild intermittent

·        Symptoms ≤ 2 times a week

·        Asymptomatic and normal PEF between exacerbations

·        Exacerbations brief (from a few hours to a few days)

≤ 2 times a month

·        FEV1 or PEF ≥ 80% predicted

·        PEF variability < 20%

Step 2

Mild persistent

·        Symptoms > 2 times a week but < 1 time a day

·        Exacerbations may affect activity

> 2 times a month

·        FEV1 or PEF ≥ 80% predicted

·        PEF variability 20-30%

Step 3

Moderate persistent

·        Daily symptoms

·        Daily use of inhaled short-acting beta2 agonists

·        Exacerbations affect activity

·        Exacerbations ≥ 2 times a week; may last days

> 1 time a week

·        FEV1 or PEF > 60% - < 80% predicted

·        PEF variability > 30%

Step 4

Severe persistent

·        Continual symptoms

·        Limited physical activity

·        Frequent exacerbations

Frequent

·        FEV1 or PEF ≤ 60% predicted

·        PEF variability > 30%

*Presence of one of the features of severity is sufficient to place a patient in that category.  An individual should be assigned to the most severe grade in which any feature occurs.  Characteristics noted in this figure are general and may overlap because asthma is highly variable. An individual’s classification may change over time.

**Patients at any level of severity can have mild, moderate, or severe exacerbations. Some patients with intermittent asthma experience severe and life-threatening exacerbations separated by long periods of normal lung function and no symptoms.

 
item2