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Chapter 21. Diagnosis and Management of Asthma

A 17-year-old woman presents to clinic for cough and wheeze. Her symptoms have been present for the past 12 weeks, and she has not received any medications for these symptoms in the past. She states her symptoms are present daily, but not throughout the day, and denies nocturnal symptoms; she has only minor limitation with physical activity. Her baseline FEV1 = 62% of predicted, which increases 10 minutes later by 14% and 240 mL after a one-time bronchodilator use. What is the appropriate classification of her asthma severity?

a. Intermittent

b. Mild persistent

c. Moderate persistent

d. Severe persistent

e. Very severe persistent

The most correct answer is c, moderate persistent.

The NAEPP recommends classifying the initial severity of asthma based on the frequency of symptoms, nocturnal awakenings, use of rescue bronchodilator and functional impairment (Table 21.6). The patient has moderate persistent asthma since the patient has daily symptoms and an FEV1 = 62% of predicted.

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Table 21.6. Classification of asthma severitya
Components of Severity Classification of Asthma Severity ≥12 years of age
Intermittent Persistent
Mild Moderate Severe

Impairment

Normal FEV1/FVC:

8-19 yr 85%

20-39 yr 80%

40-59 yr 75%

60-80 yr 70%

Symptoms ≤2 days/week >2 days/week but not daily Daily Throughout the day
Nighttime awakenings ≤2×/month 3-4 × /month >1× /week but not nightly Often 7 × /week
Short-acting beta2-agonist use for symptom control [not prevention of exercise-induced bronchospasm (EIB)] ≤2 days/week >2 days/week but not daily, and not more than 1× on any day Daily Several times per day
Interference with normal activity None Minor limitation Some limitation Extremely limited
Lung function

Normal FEV1 between exacerbations

FEV1 >80% predicted

FEV1/FVC normal

FEV1 >80% predicted

FEV1/FVC normal

FEV1 >60% but <80% predicted

FEV1/FVC reduced 5%

FEV1 <60% predicted

FEV1/FVC reduced >5%

aData from the National Asthma Education and Prevention Program Expert Panel Report 3. "Guidelines for the Diagnosis and Management of Asthma." US Dept. H&HS; 2007.

A 27-year-old woman presents to clinic for follow-up of her asthma. Over the past 6 months, she has been on fluticasone 100 μg/salmeterol 50 μg, one puff b.i.d. She reports no daytime symptoms, no nocturnal symptoms, and has not used albuterol for rescue in the past 3 months. She reports no interference with daily activities from her asthma and has not required any systemic steroids for asthma over the past year. Spirometry reveals ...

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