Asthma Classification and Control
Abbreviations:#
ACT = Asthma Control Test
ACQ = Asthma Control Questionnaire
ATAQ = Asthma Therapy Assessment Questionnaire
EIB = exercise-induced bronchospasm
FEV1 = forced expiratory volume in 1 second
FVC = forced vital capacity
Long-term management of asthma in children 0-4 years of age#
| Components of control | Well-controlled | Not well-controlled | Very poorly controlled | |
| Impairment | Symptoms | ≤2 days/week | >2 days/week | Throughout the day |
| Nighttime awakenings | ≤1x/month | >1x/month | >1x/week | |
| Interference with normal activity | None | Some limitation | Extremely limited | |
| Short-acting beta2-agonist use for symptom control (not prevention of EIB) | ≤2 days/week | >2 days/week | Several times per day | |
| Risk | Exacerbations requiring oral systemic corticosteroids | 0-1/year | 2-3/year | >3/year |
| Treatment-related adverse effects | Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. | |||
| Recommended action for treatment See: Stepwise approach for management of asthma. | Maintain current treatment.Regular follow-ups every 1-6 months. Consider step down if well controlled for at least 3 months. | Step up 1 step, and reevaluate in 2-6 weeks. If no clear benefit in 4-6 weeks, consider alternative diagnoses or adjusting therapy. For side effects, consider alternative treatment options. | Consider short course of oral systemic corticosteroids. Step up 1-2 steps, and reevaluate in 2 weeks.If no clear benefit in 4-6 weeks, consider alternative diagnoses or adjusting therapy. For side effects, consider alternative treatment options. | |
Adapted from: Cloutier MM, et al. 2020 Focused Updates to the Asthma Management Guidelines
Long-term management of asthma in children 5-11 years of age#
| Components of control | Well-controlled | Not well-controlled | Very poorly controlled | |
| Impairment | Symptoms | ≤2 days/week but not more than once on each day | >2 days/week or multiple times on ≤2 days/week | Throughout the day |
| Nighttime awakenings | ≤1x/month | ≥2x/month | ≥2x/week | |
| Interference with normal activity | None | Some limitation | Extremely limited | |
| Short-acting beta2-agonist use for symptom control (not prevention of EIB) | ≤2 days/week | >2 days/week | Several times per day | |
| Lung functionFEV1or peak flowFEV1/FVC | >80% predicted/personal best>80% | >60-80% predicted/personal best75-80% | <60% predicted/personal best<75% | |
| Risk | Exacerbations requiring oral systemic corticosteroids | 0-1/year | ≥2/year | |
| Consider severity and interval since last exacerbation. | ||||
| Reduction in lung growth | Evaluation requires long-term follow-up | |||
| Treatment-related adverse effects | Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. | |||
| Recommended action for treatment See: Stepwise approach for management of asthma. | Maintain current step. Regular follow-ups every 1-6 months. Consider step down if well controlled for at least 3 months. | Step up at least 1 step, and reevaluate in 2-6 weeks. For side effects, consider alternative treatment options. | Consider short course of oral systemic corticosteroids.Step up 1-2 steps, and reevaluate in 2 weeks. For side effects, consider alternative treatment options. | |
Adapted from: Cloutier MM, et al. 2020 Focused Updates to the Asthma Management Guidelines
Long-term management of asthma in youth ≤12 years of age and adults#
| Components of control | Well-controlled | Not well-controlled | Very poorly controlled | |
| Impairment | Symptoms | ≤2 days/week | >2 days/week | Throughout the day |
| Nighttime awakenings | ≤2x/month | 1-3x/month | ≥4x/week, but not nightly | |
| Interference with normal activity | None | Some limitation | Extremely limited | |
| Short-acting beta2-agonist use for symptom control (not prevention of EIB) | ≤2 days/week | >2 days/week | Several times per day | |
| FEV1 or peak flow | >80% predicted/personal best | 60-80% predicted/personal best | <60% predicted/personal best | |
| Validated Questionnaires ATAQ ACQ ACT | 0 ≤0.75* ≥20 | 1-2 ≤1.5 16-19 | 3-4 N/A ≤15 | |
| Risk | Exacerbations requiring oral systemic corticosteroids | 0-1/year | ≥2/year | |
| Consider severity and interval since last exacerbation. | ||||
| Progressive loss of lung function | Evaluation requires long-term follow-up care | |||
| Treatment-related adverse effects | Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk. | |||
| Recommended action for treatment See: Stepwise approach for management of asthma. | Maintain current step. Regular follow-ups every 1-6 months to maintain control. Consider step down if well controlled for at least 3 months. | Step up 1 step, and reevaluate in 2-6 weeks. For side effects, consider alternative treatment options. | Consider short course of oral systemic corticosteroids.Step up 1-2 steps, and reevaluate in 2 weeks.For side effects, consider alternative treatment options. | |
*ACQ values of 0.76-1.4 are indeterminate regarding well-controlled asthma. Adapted from: Cloutier MM, et al. 2020 Focused Updates to the Asthma Management Guidelines
Related Pages#
- Medical Disorders
- Oral Health Care Considerations
- Medications
References/Websites#
- References
- Cloutier MM, et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270.
- 2021 GINA Report, Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma.