Asthma Severity: Know Where to Start
GIP Priority Message: Assess Asthma Severity
All patients should have an initial severity assessment based on measures of current impairment and future risk in order to determine type and level of initial therapy needed.
Classify asthma severity using domains of current impairment and future risk
Asthma severity is the intrinsic intensity of the asthma disease process and is measured most easily and directly in a patient who is not receiving long-term control therapy. Information gathered in the assessment of asthma severity is used to characterize the patient’s asthma in order to guide decisions for initiating therapy, after which the focus shifts to how well the patient is able to control his or her asthma by following the treatment plan. A severity assessment ensures the appropriate use of pharmacologic agents.
Both asthma severity and asthma control are determined by the same measures in two domains: 1) current impairment, and 2) future risk. The concept of impairment includes frequency and intensity of symptoms, and current or recent functional limitations experienced by the patient. The concept of risk includes the likelihood of either asthma exacerbations, progressive decline in lung function (or, for children, reduced lung growth), or risk of adverse effects from medication.
Once treatment is started, the results of the measures of impairment and risk are used to monitor asthma control rather than severity. Monitoring the level of asthma control is used to adjust medication as needed.