Asthma, Known or New Diagnosis Clinical Pathway — Severity Classification — Primary Care

Known or Suspected Asthma Clinical Pathway — Primary Care

Severity Classification

At time of diagnosis, use severity classification to initiate treatment.

Assess Symptom Severity: 0-4 yrs

    Intermittent Mild Persistent Moderate Persistent Severe Persistent
Impairment Symptoms ≤ 2 days/wk > 2 days/wk but not daily Daily Throughout the day
Nighttime awakenings 0 1-2x/mo 3-4x/mo > 1x/wk
Frequency for SABA use ≤ 2 days/wk > 2 days/wk but not daily Daily Several times daily
Normal activity interference None Minor limitation Some limitation Extremely limited
Lung function
(FEV1 or peak flow)		 N/A N/A N/A N/A
Risk Exacerbations requiring
PO steroids		 0-1 per yr ≥ 2 exacerbations in 6 mos or wheezing ≥ 4x/mo lasting > 1 day and RF for persistent asthma Generally more frequent intense events Generally more frequent intense events

 

Assess Symptom Severity: ≥ 5 yrs

    Intermittent Mild Persistent Moderate Persistent Severe Persistent
Impairment Symptoms ≤ 2 days/wk > 2 days/wk but not daily Daily Throughout the day
Nighttime awakenings ≤ 2x/mo 3-4x/mo > 1x/wk but not nightly Often 7x/wk
Frequency for SABA use ≤ 2 days/wk > 2 days/wk but not daily and not > 1x daily Daily Several times daily
Normal activity interference None Minor limitation Some limitation Extremely limited
Lung function: 5-11 yrs


FEV1
FEV1/FVC		 Normal FEV1 between exacerbations

> 80%
> 85%		 > 80%
> 80%		 60-80%
75-80%		 < 60%
< 75%
Lung function: ≥ 12 yrs

FEV1
FEV1/FVC		 > 80%
Normal		 > 80%
Normal		 60-80%
Reduced 5%		 < 60%
Reduced 5%
Risk Exacerbations requiring
PO steroids		 0-1 per yr ≥ 2x/yr Generally more frequent intense events Generally more frequent intense events