From the Guidelines
Asthma severity should be assessed by evaluating both current impairment and future risk, including domains of symptom frequency, functional limitations, and likelihood of exacerbations or progressive decline in lung function, as outlined in the expert panel report 3 (EPR-3) guidelines 1. To assess asthma severity, healthcare providers should consider the following key components:
- Current impairment: frequency and intensity of symptoms, functional limitations, and quality of life
- Future risk: likelihood of asthma exacerbations, progressive decline in lung function, or risk of adverse effects from medication The assessment of asthma severity is crucial for initiating therapy and guiding clinical decisions, and it should be done before initiating long-term control therapy, as stated in the EPR-3 guidelines 1. The specific measures used to assess severity and control are similar and include:
- Symptoms: frequency and intensity of daytime and nighttime symptoms
- Use of short-acting beta-agonists (SABAs) for quick relief of symptoms
- Limitations to normal activities because of asthma
- Pulmonary function: spirometry to obtain FEV1 and peak expiratory flow (PEF) values
- Exacerbations: frequency and severity of exacerbations requiring oral corticosteroids The EPR-3 guidelines recommend assessing asthma severity to initiate therapy and then assessing asthma control to adjust therapy, with the goal of achieving and maintaining optimal asthma control 1. Regular reassessment of asthma severity is crucial, as it can change over time, requiring adjustments to treatment intensity, which may range from as-needed rescue inhalers for mild cases to daily controller medications and possibly biologics for severe asthma, as guided by the EPR-3 guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Assessing Asthma Severity
To assess asthma severity, several methods can be used, including:
- Clinical history and spirometry, as recommended by national guidelines 2
- Forced vital capacity (FVC) and area under the reactance curve (AX) measurements, which can be used to assess small airways dysfunction and disease control in severe asthma 3
- Physician assessment and patient-reported questionnaires, which can be used to derive guideline-based asthma severity symptom components 4
- Spirometry, including measurements of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), which can be used to assess pulmonary function 5, 6
Objective and Subjective Measures
Both objective and subjective measures can be used to assess asthma severity, including:
- Objective measures, such as spirometry and FVC measurements, which can provide quantitative assessments of lung function 3, 5, 6
- Subjective measures, such as patient-reported symptoms and quality of life, which can provide information on the impact of asthma on daily life 2, 4
Classification of Asthma Severity
Asthma severity can be classified using various criteria, including:
- Guideline-based criteria, such as those recommended by the National Asthma Education and Prevention Program and the Global Initiative for Asthma 4
- Physician assessment, which can take into account patient-reported symptoms, medical history, and lung function measurements 4
- Spirometry-based criteria, such as those based on FEV1 and FVC measurements 5, 6