Bronchial Asthma: Classification

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
  • FEV1, normal between exacerbations.
  • FEV1> 80% of normal
  • FEV1/FVC> 85 %
  • FEV1 => 80% of the normal value
  • FEV1/FVC > 80 %
  • FEV1 = 60-80% of the normal value.
  • FEV1/FVC = 75-80 %
  • FEV1< 60% of normal
  • FEV1/FVC< 75 %
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
  • FEV1, normal between exacerbations.
  • FEV1> 80% of normal
  • FEV1/FVC normal
  • FEV1≥ 80% of normal value
  • FEV1/FVC normal
  • FEV1> 60 but < 80 % of normal value
  • FEV1/FVC reduced by 5
  • FEV1 <60% of normal
  • FEV1/FVC reduced by > 5%.
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.