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==Overview==
==Overview==
Asthma is classified into '''atopic and non-atopic''' types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the '''GINA severity grades''' into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.
Asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.


==Classification Based on Symptom Onset==
==Classification Based on Symptom Onset==

Revision as of 17:23, 26 February 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Asthma is classified into atopic and non-atopic types based on the onset of symptoms. Atopic refers to early-onset whereas non-atopic refers to late-onset. Despite the differentiation, a significant degree of overlap exists between the two types. The severity of symptoms is further classified based on the GINA severity grades into mild intermittent, mild persistent, moderate persistent and severe persistent asthma.

Classification Based on Symptom Onset

Early-onset Asthma (Atopic, Allergic, Extrinsic)

Late-onset Asthma (Non-Atopic, Idiosyncratic, Intrinsic)

Classification Based on GINA Severity Grade

Asthma is classified into four subgroup, namely, mild intermittent, mild persistent, moderate persistent and severe persistent based on the Global Initiative for Asthma - GINA severity grades.[1]

Mild Intermittent Asthma

Symptoms per day Symptoms per night PEF or FEV1 PEF variability
Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations. Less than or equal to twice a month ≥ 80% of predicted normal < 20%

Step 1 therapy:

Short-acting inhaled β2-agonists on need basis.[2][3]

Mild Persistent Asthma

Symptoms per day Symptoms per night PEF or FEV1 PEF variability
Symptoms more than twice a week but less than once a day. Exacerbations may affect activity and sleep. Greater than or equal to twice a month ≥ 80% 20-30%

Step 2 therapy:

  • Preferred drug of choice is once a day low-dose steroid inhalation.
  • Alternative therapies include:

Moderate Persistent Asthma

Symptoms per day Symptoms per night PEF or FEV1 PEF variability
Daily symptoms. Exacerbations more than twice a week. Exacerbations may affect activity and sleep. Daily use of bronchodilators. More than once a month 60-80% ≥ 30%

Step 3 therapy:

  • Preferred drug of choice:

Severe Persistent Asthma

Symptoms per day Symptoms per night PEF or FEV1 PEF variability
Continued symptoms. Frequent exacerbations. Limited physical activity. Frequent ≤ 60% ≥ 30%

Step 4 or Step 5 Therapy

Step 4 therapy:

Step 5 therapy:

Guidelines for Diagnosis and Management of Asthma Based On The National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR3) [6]


References

  1. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31 (1):143-78. DOI:10.1183/09031936.00138707 PMID: 18166595
  2. Shim C, Williams MH (1980) Bronchial response to oral versus aerosol metaproterenol in asthma. Ann Intern Med 93 (3):428-31. PMID: 7436160
  3. Shim C, Williams MH (1981) Comparison of oral aminophylline and aerosol metaproterenol in asthma. Am J Med 71 (3):452-5. PMID: 7282733
  4. Berridge MS, Lee Z, Heald DL (2000) Pulmonary distribution and kinetics of inhaled [11Ctriamcinolone acetonide.] J Nucl Med 41 (10):1603-11. PMID: 11037987
  5. Nelson HS (2001) Advair: combination treatment with fluticasone propionate/salmeterol in the treatment of asthma. J Allergy Clin Immunol 107 (2):398-416. DOI:10.1067/mai.2001.112939 PMID: 11174215
  6. Urbano FL (2008) Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm 14 (1):41-9. PMID: 18240881

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