Asthma Medications and Devices: Classification of Asthma

National guidelines set goals to improve care of asthmatic patients. Simple, straightforward objectives are set forth, including the prevention of chronic symptoms, maintaining normal lung function and activity levels, preventing exacerbations, and lessening the need for emergency department visits and hospitalizations. The guidelines set out a stepwise approach to classifying asthma severity and managing asthma symptoms.

This classification system (TABLE 1) is a continuum, and the disease can be expected to change from step to step during a patient’s lifetime. Factors that may influence a patient’s class of asthma include exposure to allergens, seasonal changes, and medication regimens. Classification is based on frequency of symptoms, need for inhaled beta2 agonists, nocturnal symptoms, and lung function based on peak expiratory flow rate (PEFR) and forced expiratory volume in the first second of exhalation (FEV1). Classifications range from mild-intermittent to mild-, moderate-, and severe-persistent. Treatment with both quick-relief medications and chronic anti-inflammatory therapy is dictated by a patient’s asthma classification.

Table 1NAEPP Guidelines for Grading Asthma Severity Based on Symptoms
STEP	SYMPTOMS	NIGHT-TIME SYMPTOMS	PULMONARY FUNCTION
Step 4Severe Persistent	Continual symptomsLimited physical activity	Frequent	FEV1 or PEFR < or = to 60% predictedPEFR variability >30%
	Frequent exacerbations
Step 3	Daily symptoms	> or = to 1 time a week	FEV1 or PEFR >60% but < or = to 80% predicted
Moderate Persistent	Daily use of inhaled short cting beta₂ agonist Exacerbations affect activityExacerbations > or = to 2 times a week; may last days		PEFR variability >30%
Step 2	Symptoms >2 times a week but <1 time a day	>2 times a month	FEV1 or PEFR > or = 80% predicted
Mild Persistent	Exacerbations may affect activity		PEFR variability 20%–30%
Step 1	Symptoms < or = to 2 times a week	< or = to 2 times a month	FEV1 or PEFR > or = to 80% predicted
Mild Intermittent	Asymptomatic and normal PEF between exacerbationsExacerbations brief (from a few hours to a few days); variable intensity		PEFR variability <20%
FEV1 = Forced Expiratory Volume at 1 second, PEFR = Peak expiratory Flow Rate, PEF variability = Variability between morning and evening PEF.

John Buducci

He knows everything about medications – to which pharmacological group the drug belongs, what components are included in its composition, how it differs from its analogs, what indications, contraindications, and side effects remedy has. John is a real pro in his field, so he knows all these subtleties and wants to tell you about them.