Assessing severity and initiating therapy in children who are not currently taking long-term control medication.
The level of severity is determined by both impairment and risk.
NB: Kids 0-4 years old can’t do spirometry, so it’s not included.
| Components of severity | Classification of asthma severity (0 to 4 years of age) | ||||
| Intermittent | Persistent | ||||
| Mild | Moderate | Severe | |||
| Impairment | Symptoms | ≤2 days/week | >2 days/week but not daily | Daily | Throughout the day |
| Nighttime awakenings | 0 | 1 to 2 times/month | 3 to 4 times/month | >1 time/week | |
| Short-acting beta2 agonist use for symptom control (not prevention of EIB) | ≤2 days/week | >2 days/week but not daily | Daily | Several times per day | |
| Interference with normal activity | None | Minor limitation | Some limitation | Extremely limited | |
| Risk | Exacerbations requiring oral systemic glucocorticoids | 0 to 1/year | ≥2 exacerbations in six months requiring oral systemic glucocorticoids, or ≥4 wheezing episodes/one year lasting >1 day AND risk factors for persistent asthma | ||
| Consider severity and interval since last exacerbation | |||||
| Frequency and severity may fluctuate over time | |||||
| Exacerbations of any severity may occur in patients in any severity category | |||||
| Recommended step for initiating treatment | Step 1 | Step 2 | Step 3 and consider a short course of oral systemic glucocorticoids | ||
| In two to six weeks, depending on severity, evaluate the level of asthma control that is achieved. If no clear benefit is observed in four to six weeks, consider adjusting therapy or alternative diagnoses. | |||||
Image version: https://www.timeofcare.com/wp-content/uploads/2016/08/AsthmaSeverityClassification0-4.jpg
- Assess impairment domain by patient’s/caregiver’s recall of the previous 2 to 4 weeks.
- Is asthma better or worse since the last visit?
- Assign severity to the most severe category in which any feature occurs.
- At present, data are inadequate to correlate frequencies of exacerbations with different levels of asthma severity. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic glucocorticoids in the past 6 months, or ≥4 wheezing episodes in the past year, and who have risk factors for persistent asthma may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma. EIB: exercise-induced bronchospasm.
References / Resources