Asthma

And oxygen therapy
Comparison: PO steroid dosage vs Inhaled steroid
PFT's

Classification of Asthma Severity: Clinical Features Before Treatment(1)

Step 1: Mild Intermittent

• symptoms per week: 2 or fewer per week
  • between exacerbations: asymptomatic and normal peak expiratory flow (PEF)
  • brief exacerbations: a few hours to a few days; intensity may vary
• nighttime symptoms: 2 or fewer per month
• FEV1 or PEF 80% or more of predicted; PEF variability 19% or less
• Daily med: no steroids needed

Step 2: Mild Persistent

• symptoms per week: 3 or more per week AND not daily
  • exacerbations may affect activity
• nightime symptoms: 3 or more per month
• FEV1 or PEF 80% or more of predicted; PEF variability 20-30%
• Daily med:
  • cromolyn or nedocromil OR
  • low dose inhaled corticosteroids
  • If older than age 5 consider also leukotriene modifiers or theophylline (not preferred)

Step 3: Moderate Persistent

• symptoms per week: daily
  • exacerbations affect activity
  • exacerbations 2 or more times per week; may last days
  • daily use of short acting bronchodilator
• nightime symptoms: 2 or more per week
• FEV1 or PEF 60-80% or more of predicted; PEF variability >30%
• Daily meds:
  • medium dose inhaled corticosteroids and consider adding long acting bronchodilator (substitute nedocromil if < 5 yo)

Step 4: Severe Persistent

• continual symptoms
• limited physical activity
• frequent exacerbations
• nighttime symptoms: frequent
• FEV1 or PEF 60% or less of predicted; PEF variability >30%
• daily med: high dose inhaled corticosteroids + long acting bronchodilator  + systemic corticosteroids (if < 5yo do not give long acting bronchodilators, and systemic corticosteroids are given on a per-case basis)

* The 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. The characteristics noted in this figure are general and may overlap because asthma is highly variable. Furthermore, 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.

1. from Na t i o n a l A s t h m a E d u c a t i o n a n d P r e v e n t i o n P r o g r a m
CLINICAL PRACTICE GUIDELINES, EXPERT PANEL REPORT 2
Guidelines for the Diagnosis and Management of Asthma, NIH PUBLICATION NO. 97-4051
JULY 1997 NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute