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Classification based on symptoms, function and treatment

Description
The first column describes severity grading in patients without medication. For patients under therapy classification of severity must be based on clinical symptoms present and current treatment step (see column 2, 3 and 4): For example if a patient treated with Step 2 medication shows symptoms according to grade 2, asthma severity must be classified as "moderate persistent".

Different attempts of asthma classification

It has been shown that asthma classification on the basis of symptom assessment relates to pathological indices of airway inflammation. Therefore asthma is classified according to the severity grades "intermittent", "mild persistent", "moderate persistent" and "severe persistent" (Grade 1 - Grade 4). This classification involving a stepwise approach facilitates decisions concerning the disease management at the initial assessment as well as during maintenance treatment. Before the start of treatment patients are classified according to symptoms and lung function only, during maintenance treatment classification needs to combine current treatment and symptoms present under medication.

Asthma may also be classified according to etiology (extrinsic or intrinsic) or airflow limitation. Although both approaches have to be considered in diagnosis and disease control classification of severity grades is more common and practicable.

Literature:

Bousquet J, Chanez P, Lacoste JY, Barneon G, Ghavanian n, Enander I et al. Eosinophilic inflammation in asthma. 1990. New England Journal of Medicine ; 323: 1033-1039

O'Byrne P. GINA Executive Commitee. Global strategy for asthma management and prevention. 2004. National Institutes of Health. Publication No 02-3659

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