Categorizing asthma severity

The National Asthma Education and Prevention Program (NAEPP) Expert Panel I I recommended a stepped care pharmacotherapy approach to asthma treatment b ased on an objective assessment of asthma severity using daytime symptoms, nocturnal symptoms, and physiologic lung function. The worst grade of the i ndividual variables determines overall asthma severity. With this approach, patterns of asthma severity categorization might vary among individual var iables; one variable might have a predominant effect on overall categorizat ion. During the run-in, pretreatment phase of five controlled clinical tria ls, data from 744 inhaled steroid nonusers and 685 inhaled steroid users on asthma control were collected and asthma severity categorized. In inhaled steroid nonusers nocturnal symptoms classified the majority of patients as severe, persistent, but wheeze classified 27.3% of patients as mild, interm ittent and 25.7% as mild, persistent. If the worst grade from the four asth ma symptoms was used for severity grading, most patients were categorized a s severe, persistent. beta-Agonist use and FEV1 classified most as moderate , persistent. There was poor correlation between variables in severity cate gorization. Severity grading for European patients was similar to that for U.S. patients. Applying the Expert Panel II recommended method for asthma s everity categorization to a large data set illustrates that a single variab le, nocturnal symptoms, determined to a large extent overall categorization . Development of a validated method for asthma severity categorization is e ssential for using a stepped care approach to asthma pharmacotherapy.