Classification of bronchial asthma according to severity levels.
Severity levels | Symptoms during the day | Symptoms at night | Lung function |
1: Intermittent | ≤ 2 x/week | ≤ 2 x/month | FEV1 or PEF≥ 80% of targetPEF variability < 20%. |
2: Persistent, mild | <1 x/d | > 2 x/month | FEV1 or PEF≥ 80% of targetPEF variability 20-30%. |
3: Persistent, moderate | Daily | > 1 /week | FEV1 or PEF60-80% of targetPEF variability 20-30%. |
4: Persistent, severe | Persistent | frequent | FEV1 or PEF< 60% of targetPEF variability > 30%. |
Legend
- FEV1 (expiratory one-second capacity or forced expiratory volume).
- PEF (peak flow, PEF, PEF value, peak expiratory flow).
Classification by asthma control
Classification of bronchial asthma (GINA guideline 2007)Assessment of asthma control in children 5-11 years of age.
Control parameters | Classification of asthma control(children aged 5-11 yrs. | |||
Well controlled | Partially controlled | Uncontrolled | ||
Impaired | Symptoms during the day | ≤ 2 days/week, but not more than once per day | > 2 days/week or more than once on ≤ 2 days/week. | Continuously during the day |
Waking up at night | ≤ 1 time/month | ≥ 2 times/month | ≥ 2 times/week | |
Disruption of normal activity | Not restricted | Restricted | Very limited | |
Use of short-acting beta agonists (SABA) for symptom control (not for prevention of exercise-induced bronchoconstriction, EIB) | ≤ 2 days/week | > 2 days/week | Several times a day | |
Lung function | ||||
FEV1 or peak flow measurement | > 80% normal value/personal best value | 60 to 80 % standard value/personal best value | <60% standard/personal best | |
FEV1/FVC | > 80 % | 75 to 80 % | < 75 % | |
Risks | Exacerbations requiring oral systemic glucocorticoid therapy | 0 to 1/year | ≥ 2/year | |
Note severity and interval since last exacerbation (disease episodes)* . | ||||
Treatment-related adverse effects | Adverse effects can vary in intensity from none to very unpleasant to worrisome. Intensity level does not correlate with specific level of control but should be included in the overall consideration of risks. |
The level of control is based on the most severe impairment or risk category.Legend.
- One-second capacity (FEV1; Engl : Forced Expiratory Volume in 1 second; Forced One-Second Volume).
- Peak flow (PEF; engl. : peak expiratory flow; expiratory peak flow).
Classification of asthma severity in children 5-11 years of age.
Control parameters | Classification of asthma severity in children 5-11 years of age. | ||||
Intermittent | Persistent | ||||
Light | Medium | Severe | |||
Impairment | Symptoms during the day | ≤ 2 days/week | > 2 days/week, but not daily | Daily | Continuously during the day |
Waking up at night | ≤ 2 times/month | 3-4 times/month | > 1-time/week, but not at night | Frequently7 times/week | |
Disturbance of normal activity | Not restricted | Slightly restricted | Somewhat restricted | Very limited | |
Use of short-acting beta agonists (SABA) for symptom control (not for prevention of exercise-induced bronchoconstriction; Engl.exercise induced bronchoconstriction, EIB) | ≤ 2 days/week | > 2 days/week, but not daily | Daily | Several times a day | |
Lung function |
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Risks | Exacerbations requiring oral systemic glucocorticoid therapy. | 0-1/year | ≥ 2/year | ||
Note severity and interval since last exacerbation (disease episodes). | |||||
Severity category may vary in frequency and severity over time for the patient. | |||||
Relative annual risk of exacerbation may be related to FEV1. |
Legend
- One-second capacity (FEV1; Engl : Forced Expiratory Volume in 1 second; Forced one second volume).
- Peak flow (PEF; engl. : peak expiratory flow; expiratory peak flow).
- Forced vital capacity (FVC)
Classification of asthma severity in adolescents (or ≥ 12 years) and adulthood.
Control parameters | Classification of asthma severity in adolescents (or ≥ 12 years of age) and in adults | ||||
Intermittent | Persistent | ||||
Light | Medium | Severe | |||
Impairment Normal FEV1/FVC:8-19 yrs: 85%20-39 yrs: 80%40-59 yrs: 75%60-80 yrs: 70%. | Daytime symptoms | ≤ 2 days/week | > 2 days/week but not daily | Daily | Continuously during the day |
Waking up at night | ≤ 2 times/month | 3-4 times/month | > 1-time/week, but not at night | Frequently7 times/week | |
Disturbance of normal activity | Not restricted | Slightly restricted | Somewhat restricted | Very limited | |
Use of short-acting beta agonists (SABA) for symptom control (not for prevention of exercise-induced bronchoconstriction, EIB) | ≤ 2 days/week | > 2 days/week, but not > 1 time/day | Daily | Several times a day | |
Lung function |
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Risks | Exacerbations requiring oral systemic glucocorticoid therapy. | 0-1/year | ≥ 2/year | ||
Note severity and interval since last exacerbation (disease episodes). | |||||
Severity category may vary in frequency and severity over time for the patient. | |||||
Relative annual risk of exacerbation may be related to FEV1. |
Legend
- One-second capacity (FEV1; Engl : Forced Expiratory Volume in 1 second; Forced one second volume).
- Peak flow (PEF; engl. : peak expiratory flow; expiratory peak flow).
- Forced vital capacity (FVC)
Severe asthma [guidelines: S3 guideline]
Adults:
If on therapy with maximum-dose inhaled corticosteroids (ICS) and at least one additional long-acting medication (long-acting beta-2- sympathomimetic or montelukast) or oral corticosteroids (OCS) > 6 months/year, at least one of the following applies or would apply if therapy were reduced:
- Airway obstruction: FEV1 < 80% of set point (FEV1/FVC < LLN).
- Frequent exacerbations: ≥ 2 corticosteroid exacerbations in the past 12 months;
- Severe exacerbations: ≥ 1 exacerbation with hospitalization or ventilation in the past 12 months;
- Partially controlled or uncontrolled asthma.
Children and adolescents:
When add-on therapy with a LAMA or a monoclonal antibody must be given permanently (> 6 months) and/or a high the ICS daily dose must be administered during appropriate and adequate therapy with the goal of good asthma control.