| As indicated in the GINA guidelines, the selection of a specific pharmacological treatment of the disease is generally designed on a step-wise approach and specifically established on the basis of the asthma severity level.
Table 1: GINA, 2006 Update
With regard to asthma severity classification, it is conventionally assessed by simultaneously considering all these elements: symptoms, amounts of β2-agonist
used to treat symptoms, and lung function parameters evaluated as % predicted (FEV1-Forced Expiratory Volume in 1 second; PEF-Peak Expiratory Flow). In
particular, both the level of airflow limitation and its variability enable asthma to
be subdivided by severity into four steps (Table 1):
- Intermittent
- Mild Persistent
- Moderate Persistent
- Severe Persistent
Asthma severity may change over time, and depends not only on the severity of the underlying disease but also its responsiveness to treatment.
Asthma Control
Asthma control may be defined in a variety of ways. In general, the term control may
indicate disease prevention, or even cure. However, in asthma, where neither of these
are realistic options at present, it refers to control of the manifestations of disease.
The aim of treatment should be to achieve and maintain control for prolonged periods respecting the safety of treatment, potential for adverse effects, and the cost of treatment required to achieve this goal. Currently the assessment of asthma control should include not only control of clinical manifestations, but also control of the expected future risk to the patient such as exacerbations, accelerated decline in lung function, and side-effects of treatment. In general, the achievement of good clinical control of asthma leads to reduced risk of exacerbations. However, certain patients may continue to experience exacerbations in spite of adequate interval controls. Thus, for some patient phenotypes, treatment may be selected to address the predominant problem.
Table 2 provides the characteristics of controlled, partly controlled and uncontrolled asthma as well as the assessment of future risk.
Table 2: Levels of Asthma ControL: GINA, 2010 Update
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