Using Global Initiative for Asthma guidelines to assess asthma severity inpopulations

The classification of asthmatics into severity categories is a crucial issu e for assessing the asthma burden within a community, in which a proportion of patients is currently treated. There is no epidemiological method curre ntly available. The Global Initiative for Asthma (GINA) was used to classify 4,362 patients aged 16-45 yrs (49% males, 42% taking inhaled corticosteroids), enrolled b y 545 chest specialists in France with short standardized questionnaires in cluding forced expiratory volume in one second (FEV1) measurements. Two ind ependent GMA classifications were combined, one based only on symptoms and FEV1, and the other based only on current medication, to construct a final "symptom-FEV1 medication" classification. Almost 40% of the patients classed as step 1, 30% of those classed as step 2 and 13% of those classed as step 3 in the initial symptom-FEV1-classifica tion, were allocated to categories of higher severity in the final classifi cation. The approach was validated by showing that the proportions of: 1) p atients considered by the physicians as having severe or moderately severe asthma; 2) patients with a history of hospital admission for asthma; and 3) patients with a history of emergency department visits for asthma, increas ed with severity steps in the final classification, for each step of the tw o initial independent classifications. The treatment manage plan in the Global Initiative for Asthma was not devel oped for assessing severity of asthma but rather to describe the recommende d therapy for asthma,vith different severity. This is the first attempt to assess the severity of asthma in a large population of asthmatics mostly ta king treatment, based on the Global Initiative for Asthma guidelines. The a uthors propose this simple and pragmatic procedure for a potential classifi cation which should be put to the test in other studies.