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Categorizing Asthma Severity: An Overview of National Guidelines

Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, and The George Washington University School of Medicine, Washington, District of Columbia

REPRINT REQUESTS: Gene Colice, MD, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, Telephone: 202-877-7856, Fax: 202-291-0386, Email: Gene.Colice{at}Medstar.net

Asthma is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Corticosteroids are the most effective anti-inflammatory class of medication currently available for the treatment of asthma. However, as higher doses of inhaled corticosteroids are used the risks of systemic exposure and side effects will correspondingly increase. Justification of the benefits from higher doses of inhaled corticosteroids can only be made if patients with more severe asthma can be identified. Methods to categorize asthma severity have been introduced in various national asthma management guidelines. Unfortunately, there are substantial conceptual and practical differences among these recommended approaches to asthma severity categorization. Furthermore, these recommended approaches suffer from a focus on features of asthma control, such as symptoms, short-acting beta-agonist use, and lung function rather than actual measures of asthma severity that would encompass markers of airway inflammation. Without the endpoints necessary to assess airway inflammation, current recommendations for asthma severity categorization may lead to systematic under dosing of appropriate anti-inflammatory therapy with subsequent perpetuation of the asthma exacerbation cycle.

Key Words: Asthma • Severity of illness index • Therapeutics • Bronchodilator agents • Administration, inhalation

This article has been cited by other articles:

				D. S. Theodoropoulos The Need for a Meaningful and Practical Classification of Asthma Severity Clin. Med. Res., August 1, 2004; 2(3): 143 - 144. [Full Text] [PDF]

				J. A. Campbell The Evolving Guideline Clin. Med. Res., August 1, 2004; 2(3): 145 - 146. [Full Text] [PDF]