What is asthma severity?
Asthma severity is the intrinsic intensity of disease. Initial clinical assessment of children who have asthma begins with determining the level of severity. A therapy step (there are six) is then chosen based on the child’s level of asthma severity. Assessment of asthma severity is made before the child is taking long-term control medication. The preferred treatment for ALL levels of persistent asthma is
an inhaled corticosteroid (ICS). Assessment is made on the basis of current spirometry (measurement of airflow) and the child’s (or caregiver’s) recall of symptoms over the previous 2–4 weeks. If the child is being treated for an acute exacerbation during the initial assessment, then asking the child (or caregiver) to recall symptoms in the period before the onset of the current exacerbation will be adequate. At regular follow-up visits medications are then adjusted as needed (step up in therapy if asthma control is inadequate or step down if asthma control is maximized).
How is asthma severity assessed?
The latest guidelines from “The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma” (National Heart, Lung, and Blood Institute, 2007) recommends that clinicians classify asthma severity by assessing current impairment and future risk. The distinction between impairment and risk emphasizes the need to consider separately asthma’s effects on current quality of life and functional capacity while also considering the risks asthma presents for adverse events in the future, such as exacerbations and progressive loss of pulmonary function. Asthma impairment and risk of asthma might respond differently to treatment.
Recommended action: Familiarize yourself with the difference between current impairment and future risk by reading What is Persistent Asthma? (D-1).
Asthma severity is the intrinsic intensity of disease. Initial clinical assessment of children who have asthma begins with determining the level of severity. A therapy step (there are six) is then chosen based on the child’s level of asthma severity. Assessment of asthma severity is made before the child is taking long-term control medication. The preferred treatment for ALL levels of persistent asthma is
an inhaled corticosteroid (ICS). Assessment is made on the basis of current spirometry (measurement of airflow) and the child’s (or caregiver’s) recall of symptoms over the previous 2–4 weeks. If the child is being treated for an acute exacerbation during the initial assessment, then asking the child (or caregiver) to recall symptoms in the period before the onset of the current exacerbation will be adequate. At regular follow-up visits medications are then adjusted as needed (step up in therapy if asthma control is inadequate or step down if asthma control is maximized).
How is asthma severity assessed?
The latest guidelines from “The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma” (National Heart, Lung, and Blood Institute, 2007) recommends that clinicians classify asthma severity by assessing current impairment and future risk. The distinction between impairment and risk emphasizes the need to consider separately asthma’s effects on current quality of life and functional capacity while also considering the risks asthma presents for adverse events in the future, such as exacerbations and progressive loss of pulmonary function. Asthma impairment and risk of asthma might respond differently to treatment.
Recommended action: Familiarize yourself with the difference between current impairment and future risk by reading What is Persistent Asthma? (D-1).
Identify persistent asthma
Step 1.
Does the student have persistent asthma?
The classification of persistent is based on clear clinical criteria. If ANY of the following items is true, the student has persistent asthma. Students with persistent asthma and should be on a daily control medicine; the preferred treatment for all levels of persistent asthma is inhaled corticosteroid.
Recommended action: Complete the Checklist for Identifying Persistent Asthma (D-3).
Does the student have persistent asthma?
The classification of persistent is based on clear clinical criteria. If ANY of the following items is true, the student has persistent asthma. Students with persistent asthma and should be on a daily control medicine; the preferred treatment for all levels of persistent asthma is inhaled corticosteroid.
- The student has a current prescription for regular use of any of the following medications or any other daily control medication for asthma: Flovent®, QVar®, Pulmicort® (budesonide), Asmanex®, Alvesco®, Advair®, Symbicort®, Dulera®, theophylline, Singulair®, Intal®, Tilade®
- The student has taken a systemic steroid after a severe asthma flare-up more than once in the last year, such as any of the following: Decadron, Dexamethasone, Hydrocortisone, Medrol, Methylprednisolone, Orapred, Pediapred, Prednisolone, Prednisone, Prelone, Solumedrol, Triamcinolone.
- The student is experiencing daytime asthma symptoms (cough, wheeze, shortness of breath, OR chest tightness) more than 2 days a week (past month).
- The student is awakening at night more than 2 times a month due to asthma symptoms (breathing problems or persistent coughing). This is a key indicator of uncontrolled asthma.
- The student is using quick relief medicine (ProAir®, Ventolin®, Proventil® or Xopenex®) more than 2 days a week (past month) for relief of asthma symptoms. This does NOT include students who use SABA for prevention of EIB – exercise induced bronchospasm, UNLESS student has poor endurance, prolonged recovery time after exercise, or asthma symptoms during usual activities.
- The student experiences ANY limitation in their normal activity (even a minor limitation) due to having asthma symptoms (breathing problems or persistent coughing). This includes exercise. With good asthma control, students with asthma should be able to keep up with other children their same age and size.
- The student’s FEV1 or peak flow is less than 80% of predicted and has a history of asthma.
- A student with breathing problems or persistent cough at school who has an FEV1 <80% but has not been diagnosed with asthma should be referred to the caregiver with documentation of events at school that suggest asthma for an appointment with a health care provider for a full evaluation.
- Objective measures of airflow (peak flow and FEV1) improve assessment of asthma severity, asthma control, and response to therapy. Many children and adults with asthma do not recognize the degree of airway obstruction which they are experiencing until the airway obstruction is very severe.
Recommended action: Complete the Checklist for Identifying Persistent Asthma (D-3).
Assess asthma control
Step 2.
Is asthma under control?
The asthma control status of students with persistent or high risk asthma needs to be assessed regularly. Measuring symptoms and/or lung function is how asthma control status is determined and the risk for exacerbation is managed proactively.
Recommended action: Learn the definitions of asthma control status by reviewing Assessing Asthma Control in Students (A-4).
Recommended action: Complete the Is Asthma Under Control? checklist (D-5) with a student and/or parent.
Recommended action: Use the Asthma Control Test to measure symptoms routinely for students with persistent asthma. This test will provide a score that may help a healthcare provider determine if an asthma treatment plan is working or if it might be time for a change. Choose the Asthma Control Test based on student's age. The Asthma Control Test is available online in Spanish and other languages.
Is asthma under control?
The asthma control status of students with persistent or high risk asthma needs to be assessed regularly. Measuring symptoms and/or lung function is how asthma control status is determined and the risk for exacerbation is managed proactively.
Recommended action: Learn the definitions of asthma control status by reviewing Assessing Asthma Control in Students (A-4).
Recommended action: Complete the Is Asthma Under Control? checklist (D-5) with a student and/or parent.
Recommended action: Use the Asthma Control Test to measure symptoms routinely for students with persistent asthma. This test will provide a score that may help a healthcare provider determine if an asthma treatment plan is working or if it might be time for a change. Choose the Asthma Control Test based on student's age. The Asthma Control Test is available online in Spanish and other languages.
Determine need for accommodations or special resources
Step 3.
Does the child need special accommodations or a 504 plan?
Students with asthma are covered under Title II of the American Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act (IDEA). Title II and Section 504 ensure access to federally funded services for any handicapped person. IDEA provides funds to help schools serve these students, when schools follow specific requirements.
Recommended action: Share the Know Your Child's Rights (D-4) handout with parents/guardians so they are aware of the child's rights under Title II of the American Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act (IDEA).
Does the child need special accommodations or a 504 plan?
Students with asthma are covered under Title II of the American Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act (IDEA). Title II and Section 504 ensure access to federally funded services for any handicapped person. IDEA provides funds to help schools serve these students, when schools follow specific requirements.
Recommended action: Share the Know Your Child's Rights (D-4) handout with parents/guardians so they are aware of the child's rights under Title II of the American Disabilities Act of 1990, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act (IDEA).