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==Overview==
==Overview==
Asthma is classified into four subgroup, namely, mild intermittent, mild persistent, moderate persistent and severe persistent based on the '''GINA severity grade'''.<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78. [http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID: [http://pubmed.gov/18166595 18166595]</ref>  
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'''.<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78. [http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID: [http://pubmed.gov/18166595 18166595]</ref>  


==Mild Intermittent Asthma==
==Mild Intermittent Asthma<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78.[http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID:[http://pubmed.gov/18166595 18166595]</ref>==


{| border="1" align="center" style="background:lightskyblue"  
{| border="1" align="center" style="background:lightskyblue"  
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| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability'''
|-
|-
| style="text-align:center" | less than once a week
| style="text-align:center" | Less than once a week. Brief exacerbations. Asymptomatic and normal PEFR between exacerbations.
| style="text-align:center" | less than or equal to twice a month
| style="text-align:center" | Less than or equal to twice a month
| style="text-align:center" | ≥ 80%
| style="text-align:center" | ≥ 80%
| style="text-align:center" | < 20%
| style="text-align:center" | < 20%
|}
|}


==Mild Persistent Asthma==
'''Treatment:''' Short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis.


==Moderate Persistent Asthma==
==Mild Persistent Asthma<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78.[http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID:[http://pubmed.gov/18166595 18166595]</ref>==


==Severe Persistent Asthma==
{| border="1" align="center" style="background:lightskyblue"
|-
| bgcolor="CornFlowerBlue"  style="text-align:center" |'''Symptoms per day'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability'''
|-
| style="text-align:center" | Symptoms more than twice a week but less than once a day. Exacerbations may affect activity and sleep.
| style="text-align:center" | greater than or equal to twice a month
| style="text-align:center" | ≥ 80%
| style="text-align:center" | 20-30%
|}
 
'''Treatment:'''
*Anti-inflammatory drugs such as [[cromolyn]] or [[nedocromil]] or once a day [[steroid|low-dose steroid]] inhalation.
*[[Theophylline]], [[montelukast]], [[zafirlukast]] may be considered as an alternative along with a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]].
 
==Moderate Persistent Asthma<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78.[http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID:[http://pubmed.gov/18166595 18166595]</ref>==
 
{| border="1" align="center" style="background:lightskyblue"
|-
| bgcolor="CornFlowerBlue"  style="text-align:center" |'''Symptoms per day'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability'''
|-
| style="text-align:center" | Daily symptoms. Exacerbations more than twice a week. Exacerbations may affect activity and sleep. Daily use of [[Bronchodilators#Short-acting β2-agonists|bronchodilators]]. 
| style="text-align:center" | more than once a month
| style="text-align:center" | 60-80%
| style="text-align:center" | ≥ 30%
|}
 
'''Treatment:'''
*Moderate dose of inhaled [[steroid]], ''OR''
*Low dose inhaled [[steroid]] along with inhaled [[Bronchodilators#Long-acting β2-agonists|long-acting β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] for nocturnal symptoms, ''OR''
*Moderate doses of inhaled [[steroid]] along with long-acting bronchodilators (such as [[Bronchodilators#Long-acting β2-agonists|inhaled β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]]) and/or a short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] on need basis.
 
==Severe Persistent Asthma<ref name="pmid18166595">Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M et al. (2008)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18166595 Global strategy for asthma management and prevention: GINA executive summary.] ''Eur Respir J'' 31 (1):143-78.[http://dx.doi.org/10.1183/09031936.00138707 DOI:10.1183/09031936.00138707] PMID:[http://pubmed.gov/18166595 18166595]</ref>==
 
{| border="1" align="center" style="background:lightskyblue"
|-
| bgcolor="CornFlowerBlue"  style="text-align:center" |'''Symptoms per day'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''Symptoms per night'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF or FEV1'''
| bgcolor="CornFlowerBlue" style="text-align:center" |'''PEF variability'''
|-
| style="text-align:center" | Continued symptoms. Frequent exacerbations. Limited physical activity. 
| style="text-align:center" | Frequent
| style="text-align:center" | ≤ 60%
| style="text-align:center" | ≥ 30%
|}
 
'''Treatment:'''
*High-dose of inhaled [[steroid]] along with long-acting [[bronchodilators]] (such as [[Bronchodilators#Long-acting β2-agonists|inhaled β2-agonists]] or [[Bronchodilators#Theophylline|sustained-release theophylline]] used alone or in combination).
*Oral [[steroids]] and/or short-acting inhaled [[Bronchodilator#Short-acting β2-agonists|β2-agonists]] may be used on need basis.


==References==
==References==
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date]]


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Revision as of 14:25, 26 September 2011

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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 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[1]

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% < 20%

Treatment: Short-acting inhaled β2-agonists on need basis.

Mild Persistent Asthma[1]

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%

Treatment:

Moderate Persistent Asthma[1]

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%

Treatment:

Severe Persistent Asthma[1]

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

Treatment:

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 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

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