Asthma Classification

The NAEPP’s asthma classification contains 4 categories: Intermittent Asthma, Mild Persistent Asthma, Moderate Persistent Asthma, and Severe Persistent Asthma. This data is applicable to adults and youths of 12 years or older. Patients in the classification are not currently taking long-term control medications.

IMPAIRMENTS

Intermittent Asthma is characterized by the following impairments

  • symptoms that occur less than or equal to 2 days per week
  • nighttime awakenings of less than or equal to 2 times per month
  • need for a short-acting bronchodilator to be used for symptom control for less than or equal to 2 days per week
  • no interference with normal activity
  • pulmonary function testing showing a forced expiratory volume in one second (FEV-1) of greater than 80% of predicted and a normal FEV-1/FVC* (forced vital capacity)

*FEV-1 is the maximum amount of air one can exhale forcefully and rapidly in the first second after a deep inspiration.
*Forced Vital Capacity or FVC is the maximum amount of air one can exhaled forcefully and rapidly after a deep inspiration.

Normal FEV-1/FVC
  • 0-19 years: 85%
  • 20-39 years: 80%
  • 40-59 years: 75%
  • 60-80 years: 70%

Mild Persistent Asthma is characterized by the following impairments

  • symptoms that occur more than 2 times per week, but not daily
  • nighttime awakenings of 3 to 4 times per month
  • need for a short-acting bronchodilator to be used for symptom control for greater than 2 days per week, but not greater than 1 time per day
  • minor limitation of normal activity
  • lung function testing showing an FEV-1 greater than or equal to 80% of predicted and a normal FEV-1/FVC.

Moderate Persistent Asthma is characterized by the following impairments

  • symptoms that occur daily
  • nighttime awakenings of more than 1 per week, but not nightly
  • need for a short-acting bronchodilator to be used for symptom control daily
  • some limitation of normal activity
  • lung function testing showing an FEV-1 of more than 60% but less than 80% of predicted and an FEV-1/FVC reduced 5%.

Severe Persistent Asthma is characterized by the following impairments

  • symptoms that occur throughout the day
  • nighttime awakenings of often 7 times per week
  • need for a short-acting bronchodilator to be used for symptom control several times per day
  • extreme limitation of normal activity
  • lung function testing showing an FEV-1 of less than 60% of predicted and an FEV-1/FVC reduced 5%.

RISKS

Intermittent Asthma is characterized by the following risks

  • exacerbation requiring oral systemic corticosteroids 0 to 1 times **per year
  • consider severity and interval since last exacerbation
  • frequency and severity may fluctuate over time for patients in any severity category.

Mild, Moderate, and Severe Persistent Asthma are characterized by the following risks

  • exacerbations requiring oral systemic corticosteroids 2 or more times** per year
  • consider severity and interval since last exacerbation
  • frequency and severity may fluctuate over time for patients in any severity category.

**At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma severity. In general, more frequent and intense exacerbations (e.g. requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate greater underlying disease activity. For treatment purposes, patients who had 2 or more exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma in this asthma classification.

The level of severity in the above asthma classification is determined by assessment of impairment and risk. Assess impairment domain by patient’s/caregiver’s recall of previous 2 to 4 weeks and spirometry (FEV-1 and FEV-1/FVC). Assign severity to the most severe category in which any feature occurs.


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