Asthma Management in Youths and Adults

Share this content:
ASTHMA MANAGEMENT: ≥12 YEARS OF AGE
Classifying Asthma Severity and Initiating Treatment
Assessing severity and initiating treatment for patients who
are not currently taking long-term control medications
Components of Severity Classification of Asthma Severity
(≥12 Years of Age)
Intermittent Persistent
Mild Moderate Severe
Impairment
Normal FEV1/FVC:
8−19yr 85%
20−39yr 80%
40−59yr 75%
60−80yr 70%
Symptoms ≤2 days/week >2 days/week but not daily Daily Throughout the day
Nighttime awakenings ≤2×/month 3−4×/month >1×/week but not nightly Often 7×/week
Short-acting β2-agonist use for symptom control (not prevention of EIB) ≤2 days/week >2 days/week but not daily and not more than 1× on any day Daily Several times per day
Interference with
normal activity
None Minor limitation Some limitation Extremely limited
Lung function

• Normal FEV1 between exacerbations

• FEV1 >80% predicted

• FEV1/FVC normal

• FEV1 >80% predicted

• FEV1/FVC normal

• FEV1 >60% but <80% predicted

• FEV1/FVC reduced 5%

• FEV1 <60% predicted

• FEV1/FVC reduced >5%

Risk Exacerbations requiring oral systemic corticosteroids 0−1/year ≥2/year
• Consider severity and interval since last exacerbation
• Frequency and severity may fluctuate over time for patients in any severity category
• Relative annual risk of exacerbations may be related to FEV1
Recommended Step
for Initiating Treatment
Step 1 Step 2 Step 3 Step 4 or 5
and consider short course of oral systemic corticosteroids
In 2−6 weeks, evaluate level of asthma control that is achieved and adjust therapy accordingly.
Stepwise Approach for Managing Asthma
Intermittent
Asthma
Persistent Asthma: Daily Medication
Consult with asthma specialist if Step 4 care or higher is required.
Consider consultation at Step 3.

 
Step up if
needed

(first, check
adherence,
environmental
control, and
comorbid
conditions)
————————
Assess
control

————————
Step down if
possible

(and asthma is
well controlled
at least
3 months)
 
  Step 6
Preferred:*
High-dose ICS +
LABA + oral
corticosteroid
AND
Consider
Omalizumab
for patients
who have
allergies
  Step 5
Preferred:
High-dose
ICS + LABA
AND
Consider
Omalizumab
for patients
who have
allergies
  Step 4
Preferred:
Medium-dose
ICS + LABA
Alternative:
Medium-dose ICS
+ either LTRA,
Theophylline,
or Zileuton
  Step 3
Preferred:
Low-dose
ICS + LABA
OR
Medium-dose ICS
Alternative:
Low-dose ICS +
either LTRA,
Theophylline,
or Zileuton
  Step 2
Preferred:
Low-dose ICS
Alternative:
Cromolyn,
LTRA,
or
Theophylline
Step 1
Preferred:
SABA PRN
Each Step: Patient education, environmental control, and management of comorbidities
Steps 2−4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma.

Quick-Relief Medication for All Patients

•  SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms: up to 3 treatments at 20‑min intervals as needed. Short course of oral systemic corticosteroids may be needed

•  Use of SABA >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and the need to step up treatment

NOTES

Key: EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; ICS = inhaled corticosteroid; LABA = inhaled long-acting β2‑agonist; LTRA = leukotriene receptor antagonist; SABA = inhaled short-acting β2‑agonist.

*Preferred therapy is based on Expert Panel Report 2 from 1997.

Assessing Asthma Control and Adjusting Therapy
Components of Control Classification of Asthma Control
(≥12 Years of Age)
Well Controlled Not Well Controlled Very Poorly Controlled
Impairment Symptoms ≤2 days/week >2 days/week Throughout the day
Nighttime awakenings ≤2×/month 1−3×/week ≥4×/week
Interference with normal activity None Some limitation Extremely limited
Short-acting β2-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

• 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 to 2 steps and

• Reevaluate in 2 weeks

•  For side effects, consider alternative treatment options

NOTES

Key: ACQ = Asthma Control Questionnaire®; ACT = Asthma Control Test™; ATAQ = Asthma Therapy Assessment Questionnaire®; EIB = exercise-induced bronchospasm; FEV1 = forced expiratory volume in 1 second.

*Questionnaires do not assess lung function or the risk domain.

†ACQ values of 0.76−1.4 are indeterminate regarding well-controlled asthma.

REFERENCES

Adapted from National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma 2007. U.S. Department of Health and Human Services. Available at: http://www.nhlbi.nih.gov/guidelines/
asthma/asthgdln.pdf
. Accessed on: November 26, 2012.

(Rev. 3/2018)

You must be a registered member of ONA to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Genitourinary Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Rare Cancers Regimens
Skin Cancer Regimens Drugs