5. Asthma Severity and Asthma Control

Severity and control are two different assessments of a child’s asthma. For example, a child may be a well-controlled severe persistent asthmatic or a poorly controlled mild persistent asthmatic. We will review definitions of severity and control as well as assessments.  Tables summarizing the management of asthma based on severity and control are linked here:  Asthma Stepwise Table, Asthma Follow-up Table.

Control

Definition: The degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met.

Assessing asthma control

• Asthma control focuses on two domains:
  
  
  • Reducing impairment—the frequency and intensity of symptoms and functional limitations, interference with activity of daily living, decreasing morbidity; and 
    
    
  • Reducing risk—the likelihood of future asthma exacerbations, ED, or hospitalizations progressive decline in lung function (or, for children, reduced lung growth), or medication side effects.
    
    
• Quality asthma care involves not only initial diagnosis and treatment to achieve asthma control, addressing environmental triggers, helping patients learn self-management skills, but also long-term, regular follow-up care to maintain control.
  
  
• Asthma control, compliance/adherence to medications, limitations to asthma care, asthma triggers, patient and family's expectations should be assessed at each follow up visit.
  
  
• Asthma Control Test - Adult
• Asthma Control Test - Adult (Spanish)
• Asthma Control Test - Child
• Asthma Control Test - Child (Spanish)
   
• TRACK 0-4 year olds
  
  
• Follow-up Table included also reviews definitions of control.

Severity

Definition: The intrinsic intensity of the disease process.

Assessing severity 

EPR

The EPR categorizes severity into Intermittent, Mild Persistent, Moderate Persistent and Severe Persistent. These are based on impairment and risk and varies by age. EPR3 recommends categorizing severity by symptoms of controller medications during the initial visit. No changes in EPR4 but recommended further elaboration on severity in future work.

GINA 2020

In GINA 2020, severity is assessed retrospectively based on the level of treatment required to control symptoms and exacerbations. For example, mild asthma can be controlled by step 1 or 2 pharmacotherapy; moderate asthma is controlled by steps 3 or 4 pharmacotherapy, severe asthma is controlled by step 5 of pharmacotherapy. 

• Table included compares severity definitions between GINA & EPR. Differences are highlighted. 

Risk factors

Risk factors for poor asthma outcomes are discussed in section 7. Treating Modifiable Risk Factors.

• Co-morbidities 
  
  
• Exposures 
  
  
• Socioeconomic Barriers