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Classifying asthma severity in children 5 to 11 years of age

Classifying asthma severity in children 5 to 11 years of age
Components of severity Classification of asthma severity (children 5 to 11 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 ≤2 times/month 3 to 4 times/month >1 time/week, but not nightly Often 7 times/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
Lung function
  • Normal FEV1 between exacerbations
  • FEV1 >80% predicted
  • FEV1/FVC >85%
  • FEV1 >80% predicted
  • FEV1/FVC >80%
  • FEV1 = 60 to 80% predicted
  • FEV1/FVC = 75 to 80%
  • FEV1 <60% predicted
  • FEV1/FVC <75%
Risk Exacerbations requiring oral systemic glucocorticoids 0 to 1/year (refer to legend) ≥2 in 1 year (refer to legend)
Consider severity and interval since last exacerbation
Frequency and severity may fluctuate over time for patients in any severity category
Relative annual risk of exacerbations may be related to FEV1
Classifying severity in children who are not currently taking long-term control medication. Level of severity is determined by both impairment and risk. Assess impairment domain by patient's/caregiver's recall of the previous 2 to 4 weeks and spirometry. Assign severity to the most severe category in which any feature occurs. At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma severity. In general, more frequent and intense exacerbations (eg, requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate greater underlying disease severity. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic glucocorticoids 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.
EIB: exercise-induced bronchoconstriction; FEV1: forced expiratory volume in the first second; ICU: intensive care unit.
Reproduced from: National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 07-4051NIH, National Heart, Lung, and Blood Institute, Bethesda, MD 2007.
Graphic 51579 Version 11.0

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