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Asthma Guideline:

Asthma  Severity Classification

Stepwise Approach to Management

MILD-INTERMITTENT ASTHMA

Symptoms ≤2 times per week

. Asymptomatic between flares

     Normal peak flow between flares

     Flares brief

     Nighttime symptoms ≤ 2 times per month

     FEV1 or peak flow ≥ 80% of predicted

.     Peak flow variability  <20%

STEP 1

  * No daily medication needed

Short acting β-agonist as needed

MILD-RSISTENT ASTHMA

     Symptom. >2 times per week but <1 time per day

     Flame may affect activity

     Nighttime symptoms >2 times per month

.     FEV1 or peak flow ≥ 80% of predicted

     Peek flow variability 20% to 30%

 

STEP 2

     Daily anti-inflammatory medication

-          Low dose inhaled corticosteroids

-          Nedocromil or cromolyn

-          Sustained-release theophylline

-          Antileukotriene agents  

. Short acting β-agonist as needed

MODERATE-PERSISTENT ASTHMA

   Daily symptoms

.   Daily use of inhaled β-agonist

.   Flares affect activity ≥ 2  tines per week and may last days

   Nighttime symptoms > 1 time per week

.   FEV1 or peak flow > 60% but  ≤ 80% of predicted

.   Peak flow variability > 30%

 

STEP 3

-          Daily anti-inflammatory medication

         medium dose inhaled corticosteroid

OR

         low to medium-dose inhaled corticosteroids

PLUS

Long acting bronchodilator , especially for night symptoms

-Long-acting inhaled or oral β-agonist

-          Sustained release theophylline    

IF NEEDED

     Medium- to high-dose inhaled corticosteroids

AND

. Long-acting bronchodilator

-Long-acting inhaled or oral β-agonist

-Sustained release theophylline

 

I997 NAEP guidelines