Classification of Asthma

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Asthma may be divided into four clinical phases, based on symptoms and pulmonary function testing. These stages allow physicians to communicate about asthma severity and provide general guidelines on treatment. The four categories include mild intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent

Table 13 Classification of Asthma Severity

Category

Symptoms

Nocturnal symptoms

Pulmonary function

Mild

Less than twice weekly

Less than twice monthly

Both FEV1 and PEFR

intermittent

Normal between attacks Attacks brief and usually mild

>80% predicted

Mild

More than twice a week,

More than twice weekly

Both FEV1 and PEFR

persistent

less than daily Attacks limit activity monthly

>80% predicted

Moderate

Daily symptoms

More than weekly

FEV1 and PEFR

persistent

Daily use of medications Attacks affect activity Attacks usually more than twice a week and may be severe and last days to weeks

60-80% predicted

Severe

Continuous symptoms

Frequent, up to every

FEV1 and PEFR

persistent

Limited physical activity Frequent exacerbations

night

<60% predicted

PEFR, peak expiratory flow rate.

PEFR, peak expiratory flow rate.

asthma. These categories advance in severity and a patient may move from one to another depending on various circumstances. Table 13 shows details of the current classification scheme.

Mild intermittent asthma occurs less than twice weekly, and the patient is asymptomatic otherwise. Pulmonary function is normal except during periods of disease, and exacerbations are brief and usually easily treated.

Mild persistent disease occurs more than twice a week, but less than once a day. Symptoms are severe enough to interfere with daily activities and may interrupt sleep up to twice a month. Moderate persistent disease occurs on a daily basis and requires regular use of medications. This stage of asthma is moderately inconvenient, with patients constantly aware of their disease, requiring medications on a daily basis, having their sleep interrupted at least weekly, and having to accommodate their lifestyle to the disease.

Severe asthma has continuous symptoms despite medications, which limit activity and are associated with frequent exacerbations and sleep interruptions.

A patient with mild persistent disease can be exposed to allergens or develop a cold and have a severe exacerbation of his asthma symptoms, which places him in the severe persistent classification until the attack is resolved. Conversely, a patient with severe persistent symptoms can be treated effectively and have resolution of symptoms, with reclassification to a mild persistent category while he or she takes medications.

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Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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