1. Assessing Risk (Future) Domain – Of adverse events in the future, especially of exacerbations and of progressive, irreversible loss of pulmonary function—is more problematic (airway remodeling) – The test most used for assessing the risk of future adverse events is spirometry

2. Measures of Assessment & Monitoring Diagnosis

3. Key Points – Diagnosis of Asthma To establish a diagnosis of asthma the clinician should determine that: – Episodic symptoms of airflow obstruction or airway hyperresponsiveness are present – Airflow obstruction is at least partially reversible – Alternative diagnoses are excluded

4. Key Points – Methods to Establish Diagnosis Recommended methods to establish the diagnosis are: – Detailed medical history – Physical exam focusing on the upper respiratory tract, chest, and skin – Spirometry to demonstrate obstruction and assess reversibility, including in children 5 years of age or older – Additional studies to exclude alternate diagnoses

5. Key Indicators: Diagnosis of Asthma Has/does the patient: – had an attack or recurrent attacks of wheezing? – have a troublesome cough at night? – wheeze or cough after exercise? – experience wheezing, chest tightness, or cough after exposure to airborne allergens or pollutants? – colds ‘go to the chest’ or take more than 10 days to clear up? – symptoms improved by appropriate asthma treatment?

6. Characterization & Classification of Asthma Severity

7. Key Points - Initial Assessment: Severity  Once a diagnosis is established: –Identify precipitating factors (triggers) –Identify comorbidities that aggravate asthma –Assess the patient’s knowledge and skills for self-management –Classify severity using impairment and risk domains  Pulmonary function testing (spirometry) to assess severity

8. Assessment of Asthma Severity Previous Guidelines Frequency of daytime symptoms Frequency of nighttime symptoms Lung function 2007 Guidelines Impairment –Frequency of daytime /nighttime symptoms –Quality of life assessments –Frequency of SABA use –Interference with normal activity –Lung function (FEV 1 /FVC) Risk –Exacerbations (frequency and severity)

9. NOT Currently Taking Controllers Level of severity is determined by both impairment and risk. Assess impairment by caregivers recall of previous 2-4 weeks.

10. NOT Currently Taking Controllers

12. Classifying Severity AFTER Control is Achieved – All Ages Lowest level of treatment required to maintain control Classification of Asthma Severity IntermittentPersistent Step 1 MildModerat e Severe Step 2 Step 3 or 4 Step 5 or 6 (already on controller)