Table 2. Assessing Control and Adjusting Therapy – Youth ≥ 12 Years of Age and Adults
Classification of Asthma Control
Components of Control Symptoms
Night-time awakenings
Interference with normal activity
Short-acting β2
Lung function > FEV1
-agonist
use for symptom control (not prevention of EIB)
or peak flow
Validated questionnaires* ATAQ ACQ ACT
Exacerbations
> 80% predicted/ personal best
0
≤ 0.75 ≥ 20
0-1/year
> Maintain current treatment
> Consider step down if well controlled for at least 3 months
60-80% predicted/ personal best
1-2
≥ 1.5 16-19
2-3/year
> Step up (1 step) > Reevaluate in 2-6 weeks
> For side effects, consider alternative treatment options
< 60% predicted/ personal best
3-4
N/A ≤ 15
> 3/year
> Consider short course of systemic oral corticosteroids
> Step up (1-2 steps) > Revaluate in 2 weeks
> For side effects, consider alternative treatment options
Treatment-related adverse effects
Medication side effects can vary in intensity from none to very troublesome and worrisome. The level of intensity does not correlate to specific levels of control but should be considered in the overall assessment of risk.
EIB, exercise-induced bronchospasm
*Validated Questionnaires: ATAQ = Asthma Therapy Assessment Questionnaire ACQ = Asthma Control Questionnaire ACT = Asthma Control Test
Well Controlled ≤ 2 days/week
< 2×/month None
≤ 2 days/week
Not Well Controlled
> 2 days/week
1-3×/month Some limitation
> 2 days/week
Very Poorly Controlled
Throughout the day
≥ 4×/week Extremely limited Several times/day
Notes: • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.
Minimal Important Difference: 1.0 for the ATAQ; 0.5 for the ACQ; not determined for the ACT
• Symptom assessment for periods > 2 weeks should reflect global assessment, such as inquiring whether the patient's asthma is better or worse since the last visit.
• Before step-up therapy: ▶ Assess adherence to medications, environmental control, and comorbid conditions. ▶ If an alternative treatment option was used in a step, discontinue it and use a preferred treatment for that step.
3
Risk
Recommended action for treatment (Table 3)
Impairment