What Are The Classifications Of Asthma Severity And Control According To The NAEPP?

Once asthma is diagnosed, the next step is to determine its severity in order to guide therapy. The NAEPP’s third  Expert Panel Report (EPR-3) bases its classification of asthma on the frequency of asthma symptoms, the frequency of nighttime awakenings from asthma, how often a short-acting inhaled β2 (SABA) bronchodilator is required for symptom relief, the extent that asthma interferes with normal activities, and measurement of lung function (FEV1).

Based on those clinical features, a person’s asthma will fall into one of four categories: intermittent asthma, mild persistent asthma, moderate persistent asthma, or severe persistent asthma. Tables summarizing the NAEPP’s classification adapted from the EPR-3 are included in Appendix 2. A person who is experiencing daily wheeze and cough and who is waking up every other night with asthma symptoms falls into a moderate persistent asthma severity classification, for example. His or her asthma is not well controlled and treatment is unequivocally indicated. All persons with asthma should always be prescribed a short-acting, inhaled  β2 bronchodilator (SABA) for quick symptom relief.

To continue with our example, the newly diagnosed individual with not-well-controlled asthma (to use the terminology suggested by the EPR-3) needs additional therapy including anti-inflammatory medication, ideally an inhaled corticosteroid. The goal of treatment is to obtain control of asthma, stepping up medicine if needed.

The EPR-3 defines three categories of asthma control: well-con-trolled, not well-controlled, and very poorly controlled. Physicians and patients alike must be able to recognize good asthma control. Studies have revealed that both groups tend to overestimate the extent of asthma control at the same time that they underestimate the severity and the significance of ongoing asthma symptoms. Patients with asthma too often put up with or simply adapt to having some degree of uncontrolled asthma.

They should not accept frequent symptoms of cough, breathlessness, wheeze, or discomfort as normal, nor should they consider it acceptable to have to use their short-acting, quick-relief inhaler two times or more a week. They should never assume that activity limitation is a fact of life. Physicians and caregivers who fail to recognize that a person’s asthma is not well controlled will miss a crucial opportunity to prescribe appropriate medications for their patient. The EPR-3 emphasizes that the major components of asthma control assessment include how frequently symptoms are present by day, how many nighttime awakenings occur in a week, how often a short-acting, inhaled  β2 bronchodilator medication is required for symptom relief, measurement of lung function (FEV1), and the frequency and severity of exacerbations .

The goal of well-controlled asthma is attained when a person with asthma (aged 12 years and older) experiences few or no asthma symptoms (no more often than twice a week), has minimal nighttime awakenings from asthma (no more than twice a month), has no interference with his or her daily activities and routines, and has no need to use a short-acting, quick-relief inhaled  β2 bronchodilator medicine more often than twice a week.

Lung function should be close to normal as indicated by an FEV1 value or PEF value of 80% of predicted. Well-controlled asthma should lead to no more than one exacerbation during a year. Once asthma becomes well-controlled, the EPR-3 advises consideration of stepping down asthma medications to adjust the medicine to maintain control with minimal dosages and potential side effects.