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The National Heart, Lung and Blood Institute of the National Institute of Health has devised a standard way of classifying the types of asthma
1) Mild Intermittent Asthma
- Asymptomatic and normal air flow between episodes
- Exacerbations brief (from a few hours to a few days); intensity may vary
- Forced air flow parameters (as measured by pulmonary function testing) > 80% predicted value
- Forced air flow parameters (as measured by pulmonary function testing) variability < 20%
Generally, no daily medications are needed. Exacerbations may be severe but are separated by long periods of normal lung function. Medications are prescribed on an “as needed” basis only. Oral corticosteroids may be recommended.
2) Mild Persistent Asthma
- Symptoms may affect activity
- Forced air flow parameters (as measured by pulmonary function testing) > 80% predicted
- Forced air flow parameters (as measured by pulmonary function testing) variability 20%-30%
This type of asthma may be managed with daily "anti-inflammatory" medications. Often, inhaled corticosteroids or non-steroidal anti-inflammatory medications are prescribed to prevent symptoms. Additionally, a short-acting “bronchodilator" medication may be prescribed to relieve symptoms (see "medication" section). The pulmonologist will need to evaluate a child with mild persistent asthma every 3 to 6 months.
3) Moderate Persistent Asthma
- Daily use of inhaled short-acting bronchodilator medication
- Symptoms affect activity
- Exacerbations > 2 times a week, may last days
- Forced air flow parameters (as measured by pulmonary function testing) > 60% - < 80% predicted
- Forced air flow parameters (as measured by pulmonary function testing) variability > 30%
This type of asthma is usually managed by a daily inhaled "anti-inflammatory" medication (corticosteroid), medium to high dosage as needed. A long-acting “bronchodilator” medication may be added if needed (see “medication” section). The pulmonologist will need to evaluate a child with moderate persistent asthma every 2 to 3 months, until improvement is achieved.
4)
Severe Persistent Asthma
- Continual symptoms
- Frequent nighttime symptoms
- Limited physical activity
- Frequent exacerbations
- Forced air flow parameters (as measured by pulmonary function testing) < 60% predicted
- Forced air flow parameters (as measured by pulmonary function testing) variability > 30%
This type of asthma is usually managed by daily inhaled "anti-inflammatory" medication, usually at a high dosage. A long-acting “bronchodilator” medication will most likely be added to achieve control. The pulmonologist will need to evaluate a child with severe persistent asthma every 2 - 6 weeks, until improvement is achieved.
Oral corticosteroids are prescribed when needed depending on the severity of symptoms.
5)
Exercise-Induced Asthma
- Symptoms of cough, wheeze, shortness of breath, chest tightness related to exercise
- May occur with or without persistent asthma symptoms (as described above
- Abnormal pulmonary function testing when exercising, baseline usually normal
This type of asthma is usually managed with a bronchodilator medication prior to exercise. Daily medications are usually not necessary. Exercise-stress testing may be recommended. |
