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Frequency and severity may fluctuate over time Exacerbations of any severity may occur in patients in any severity category Classifying severity in children who are not currently taking long-term control medication. Level of severity is determined by both impairment and risk. Assess impairment domain by caregiver's recall of previous 2-4 weeks. Assign severity to the most severe category in which any feature occurs. At present, there are inadequate data to correspond frequencies of exacerbations with different levels of asthma severity. For treatment purposes, patients who had ≥2 exacerbations requiring oral corticosteroids in the past 6 months, or ≥4 wheezing episodes in the past year, and who have risk factors for persistent asthma may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma. Reproduced from: National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma. NIH Publication no. 08-4051, 2007. Classifying asthma severity in children 5-11 years of age Components of severity Classification of asthma severity (children 5-11 years of age) Intermittent Persistent Mild Moderate Severe Impairment Symptoms ≤2 days/week >2 days/week but not daily Daily Throughout the day Nighttime awakenings ≤2x/month 3-4x/month >1x/week but not nightly Often 7x/week Short-acting beta 2 -agonist use for symptom control (not prevention of EIB) ≤2 days/week >2 days/week but not daily Daily Several times per day Interference with normal activity None Minor limitation Some limitation Extremely limited Lung function • Normal FEV 1 between exacerbations • FEV 1 >80 percent predicted • FEV 1 /FVC >85 percent • FEV 1 = >80 percent predicted • FEV 1 /FVC >80 percent • FEV 1 = 60-80 percent predicted • FEV 1 /FVC = 75-80 percent • FEV 1 <60 percent predicted • FEV 1 /FVC <75 percent Risk