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    NAEPP EPR-3 Classifi Cation of Asthma Severity & Control in Children 0-4 Years of Age

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    Adriel Chandra Ang
    This document from the NAEPP EPR-3 provides guidelines for classifying the severity and control of asthma in children ages 0-4. It defines the components of severity and control, including impairment, risk, exacerbations, and treatment levels. Asthma severity is classified as intermittent, mild, moderate, or severe based on impairment frequency. Control is classified as well-controlled, not well-controlled, or very poorly controlled based on similar impairment criteria. The document provides treatment recommendations based on the severity and control classifications.

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    NAEPP EPR-3 Classifi Cation of Asthma Severity & Control in Children 0-4 Years of Age

    Uploaded by

    Adriel Chandra Ang
    12 views1 page
    This document from the NAEPP EPR-3 provides guidelines for classifying the severity and control of asthma in children ages 0-4. It defines the components of severity and control, including impairment, risk, exacerbations, and treatment levels. Asthma severity is classified as intermittent, mild, moderate, or severe based on impairment frequency. Control is classified as well-controlled, not well-controlled, or very poorly controlled based on similar impairment criteria. The document provides treatment recommendations based on the severity and control classifications.

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    asthma

    Original Title

    AsthmaSeverityControl0-4_021610

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    This document from the NAEPP EPR-3 provides guidelines for classifying the severity and control of asthma in children ages 0-4. It defines the components of severity and control, including impairment, risk, exacerbations, and treatment levels. Asthma severity is classified as intermittent, mild, moderate, or severe based on impairment frequency. Control is classified as well-controlled, not well-controlled, or very poorly controlled based on similar impairment criteria. The document provides treatment recommendations based on the severity and control classifications.

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    12 views1 page

    NAEPP EPR-3 Classifi Cation of Asthma Severity & Control in Children 0-4 Years of Age

    Uploaded by

    Adriel Chandra Ang
    This document from the NAEPP EPR-3 provides guidelines for classifying the severity and control of asthma in children ages 0-4. It defines the components of severity and control, including impairment, risk, exacerbations, and treatment levels. Asthma severity is classified as intermittent, mild, moderate, or severe based on impairment frequency. Control is classified as well-controlled, not well-controlled, or very poorly controlled based on similar impairment criteria. The document provides treatment recommendations based on the severity and control classifications.

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    NAEPP EPR-3 Classification of Asthma Severity & Control in Children 0-4 Years of Age

    Classifying Asthma Severity & Initiating Treatment


    Classification of Asthma Severity

    Impairment

    Components of Severity

    Persistent

    Intermittent

    Symptoms

    > 2 days/week but not daily

    Daily

    Throughout the day

    1-2x/month

    3-4x/month

    > 1x/week

    2 days/week

    > 2 days/week but not daily

    Daily

    Several times/day

    None

    Minor limitation

    Some limitation

    Extremely limited

    0-1/year
    Risk

    Severe

    Interference with Normal Activity

    Exacerbation requiring OSC

    Moderate

    2 days/week

    Nighttime Awakenings
    SABA Use (other than for EIB)

    Mild

    2 exacerbations in 6 months requiring OSC, or 4 wheezing episodes/1 year


    lasting > 1 day AND risk factors for persistent asthma

    Consider severity and interval since last exacerbation. Frequency and severity may fluctuate over time.
    Exacerbations of any severity may occur in patients in any severity category.

    Recommended Step for


    Initiating Therapy

    Step 1

    The stepwise approach is meant to assist, not


    replace, the clinical decision making required
    to meet individual patient needs.

    Step 2

    Step 3
    and
    Consider OSC

    Step 3
    and
    Consider OSC

    In 2-6 weeks, depending on severity, evaluate level of asthma control that is achieved. If no clear benefit is
    observed in 4-6 weeks, consider adjusting therapy or alternative diagnoses.

    Classifying Severity After Asthma Becomes Well-Controlled by Lowest Level of Treatment Required to Maintain Control

    Classification of Asthma Severity


    Lowest level of treatment
    required to maintain control

    Persistent

    Intermittent
    Step 1

    Mild

    Moderate

    Step 2

    Severe

    Step 3 or 4

    Step 5 or 6

    KEY: SABA-short-acting beta2-agonist; ICS-inhaled corticosteroids; OSC-oral systemic corticosteroids; EIB-exercise induced bronchospasm
    NOTES:
    Level of severity is determined by both impairment and risk. Assess impairment domain by patients/caregivers recall of previous 2-4 weeks. Symptom assessment for longer periods should
    reflect a global assessment such as inquiring whether the patients asthma is better or worse since the last visit. Assign severity to the most severe category in which any feature occurs.
    At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma severity. For treatment purposes, patients who had 2
    exacerbations requiring oral systemic corticosteroids in the past 6 months, or 4 wheezing episodes in the past year, and who have risk factors for persistent asthma may be
    considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma.

    Classifying Asthma Control & Adjusting Treatment

    Impairment

    Components of Control
    Symptoms
    Nighttime Awakenings
    Interference with Normal Activity
    SABA Use (other than for EIB)

    Risk

    Exacerbation requiring OSC


    Treatment-related
    adverse side effects

    Recommended Action for Treatment


    The stepwise approach is meant to assist,
    not replace, the clinical decision making
    required to meet individual patient needs.

    Classification of Control
    Well Controlled

    Not Well-Controlled

    Very Poorly Controlled

    2 days/week

    > 2 days/week

    Throughout the day

    1x/month

    > 1x/month

    > 1x week

    None

    Some limitation

    Extremely limited

    2 days/week

    > 2 days/week

    Several times/day

    0-1 year

    2-3 year

    > 3/year

    Consider severity and interval since last exacerbation.


    Medication side effects vary in intensity from none to very troublesome and worrisome.
    The level of intensity does not correlate to specific levels of control but should be considered in the overall
    assessment of risk.
    Maintain current treatment.
    Regular follow-up every
    1-6 months.
    Consider step down if well
    controlled for at least 3
    months.

    Step up (1 step) AND


    Reevaluate in 2-6 weeks.
    If no clear benefit in 4-6 weeks,
    consider alternative diagnosis or
    adjusting therapy.
    For side effects, consider
    alternative treatment options.

    Consider short course of OSC.


    Step up (1-2 steps), AND
    Reevaluate in 2 weeks.
    If no clear benefit in 4-6 weeks,
    consider alternative diagnosis or
    adjusting therapy.
    For side effects, consider
    alternative treatment options.

    KEY: SABA-short-acting beta2-agonist; ICS-inhaled corticosteroids; OSC-oral systemic corticosteroids; EIB-exercise induced bronchospasm
    NOTES:
    The level of control is based on the most severe risk category. Assess impairment domain by caregivers recall of previous 2-4 weeks. Symptom assessment for longer periods
    should reflect a global assessment such as inquiring whether the patients asthma is better or worse since the last visit.
    At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma severity. In general, more frequent and intense exacerbations
    (e.g., requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate greater underlying disease severity. For treatment purposes, patients who had 2
    exacerbations requiring oral systemic corticosteroids in the past year may be considered the same as patients who have persistent asthma, even in the absence of impairment
    levels consistent with persistent asthma.
    Before step up in therapy:
    Review adherence to medication, inhaler technique, environmental control, and comorbid conditions.
    If alternative treatment option was used in a step, discontinue it and use preferred treatment for that step.
    Produced by the California Asthma Public Health Initiative (CAPHI). Based on NAEPP EPR-3 recommendations for classification of asthma severity and control for children 0-4 years of age.
    This table was designed to assist the clinician and is not intended to replace the clinicians judgment or establish a protocol for all patients with a particular condition.
    Revised 02/16/2010

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