Asthma classification

In chronic asthma, classification of asthma severity is based on daytime and nighttime symptoms, physical activity, lung function (PEF or FEVfi, PEF variability, and reliever medication use. Because lung function is difficult to measure in preschool children (children 5 years of age or younger), it cannot be used to classify disease severity in this age group. Chronic asthma is classified as mild intermittent asthma, or mild, moderate or severe persistent asthma (Table 11-1). 

Classification of asthma severity is based on daytime and nighttime symptoms, physical activity, lung function, variability in peak expiratory flow (PEF), and use of reliever medications. 

TABLE 11-1. Classification of Severity and Stepwise Approach For Managing Asthma... 

In patients with mild intermittent asthma, long-term control medications are not necessary, and patients should use a short-acting inhaled P2-agonist t° prevent or treat symptoms.2 This classification includes patients with exercise-induced asthma, seasonal asthma, or asthma symptoms associated with infrequent trigger exposure. Patients can pre-treat with two puffs of cromolyn or nedocromil prior to exposure to a known trigger. The treatment of choice for exercise-induced asthma is two inhalations of albuterol 5 minutes prior to exercise.1 Cromolyn and nedocromil are less effective than albuterol for prophylaxis of exercise-induced asthma. 

Isoproterenol (104) is an important agent for classification because of its selective p-receptor agonist activity. It is of special interest that its chronotropic (increase in heart rate) and inotropic (increase in force of contraction) effects exceed that of epinephrine it is also used in the management of mild to moderate asthma due to its bronchodilating effect, resulting in increased vital capacity of the lungs. 

Woolcock A Definitions and clinical classification in Barnes PJ, Grunsyein MM, Leff AR, Woolcock AJ (eds) Asthma. Philadelphia, Lippincott-Raven, 1997, pp 27-32. 

GR inhibitory interaction with T-bet may be an important mechanism underlying the immunosuppressive properties of GCs [27]. It is therefore important to determine the footprint of T-cell-specific transcription factor expression and binding on the IFN-y promoter in asthmatics, resulting in a closer classification of this disease. Allergic asthma is possibly a multifaceted disease that can be further better subclassified and therefore treated with different strategies. 

The classification of asthma by the level of control has been suggested in these Guidelines, and is stated in Table 6. 

Table 6. Classification of asthma by level of control (see O Byrne P et al., 2006). Levels of asthma control ...

A two-part review was published in 2002, addressing the difficulties of assessing the effects of asthma therapy on childhood growth and reviewing the published literature based on the authors recommendations (136,137). In the first part (136), a simple classification system for growth studies was developed ... 

The ARIA paper [1] summarizes current knowledge on rhinitis and its link to asthma and features several main issues, presenting a new classification of rhinitis with reference to a similar classification as is currently used for asthma. Because of the long-term exposure to seasonal allergens in some countries and the seasonal variations also observed in mite allergen exposure [2], it was decided that the terms seasonal and perennial would not be very helpful for any decision in terms of treatment. Furthermore, seasonal and perennial... 

It must be our aim to prevent the development of asthma in patients, especially in children with rhinitis, and SIT has been shown to considerably reduce the risk of disease expansion in this group of patients that otherwise would develop asthma in about 35-45% of cases. SIT clearly is a treatment of choice for common airway disease such as a reductive and preventive treatment approach. Further studies are needed to confirm this benefit and to allow a better classification of patients suitable for preventive SIT in terms of sensitizations, age and laboratory parameters. 

DOT CLASSIFICATION 6.1 Label ICEEP AWAY FROM FOOD SAFETY PROFILE Poison by ingestion, subcutaneous, and intraperitoneal routes. An experimental teratogen. Other experimental reproductive effects. An allergen and skin and eye irritant. Mutation data reported. Can cause contact dermatitis, bronchial asthma, and methemoglobinemia with cyanosis. When heated to decomposition it emits toxic fumes of NOx. 

DOT CLASSIFICATION 8 Label Corrosive SAFETY PROFILE Poison by skin contact and intraperitoneal routes. Moderately toxic by ingestion. Corrosive. A severe skin and eye irritant. High concentration of vapors causes irritation of respiratory tract, nausea, and vomiting. Repeated exposures can cause asthma and sensitization of skin. Combustible when exposed to heat or flame can react with oxidizing materials. Mixmre with... 

Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol 2001 87(3) 177-80. 

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