Table 4.
Asthma Severity in Children
| Intermittent | Mild Persistent | Moderate Persistent | Severe Persistent | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age (years) | 0–4 | 5–11 | ≥ 12 | 0–4 | 5–11 | ≥12 | 0–4 | 5–11 | ≥12 | 0–4 | 5–11 | ≥ 12 |
| Impairment | ||||||||||||
| symptoms days/week | ≤ 2 | ≤ 2 | ≤ 2 | > 2 | > 2 | > 2 | daily | daily | daily | throughout the day | ||
| Night awakening /month |
0 | ≤ 2 | ≤ 2 | 1 to 2 | 3 to 4 | 3 to 4 | 3 to 4 | > 1/w | > 1/w | >1/w | 7/w | > 7/w |
| SABA days/week | ≤ 2 | ≤ 2 | ≤ 2 | > 2 | > 2 | > 2 | daily | daily | daily | several times/day | ||
| Activity interference | none | none | none | minor | minor | minor | some | some | some | extremely limited | ||
| Lung function | ||||||||||||
| FEV1 % | - | > 80 | > 80 | ≥ 80 | > 80 | 60 to 80 | >60 <80 | < 60 | < 60 | |||
| FEV1/FVC % | - | > 85 | 85 | > 80 | > 80 | 75 to 80 | red 5% | < 75 | red>5 % |
|||
| Risk | ||||||||||||
| Exacerbations/year | 0–1 | 0–2 | 0–1 | ≥2/6mo | > 2 | ≥ 2 | > 2/6mo | > 2 | > 2/6mo | ≥ 2 | ≥ 2 | |
| Treatment | Step 1: SABA PRN | Step 2: low dose ICS | Step 3 or 4: ICS + LABA | Step 5 or 6: high dose ICS + LABA |
||||||||
| Alternative | LTRA | ICS +LTRA | Omalizumab | |||||||||
| Immunotherapy | + | + | ||||||||||
Modified from the 2007 NAEPP EPR-3. SABA- short acting beta2 agonist, LABA-long acting beta2 agonist, ICS- inhaled corticosteroid, LTRA- leukotriene receptor antagonist, FEV1-forced expiratory volume in 1 second, FVC- forced vital capacity.