Asthma

Table 7. Classifying Asthma Severity – After Asthma Becomes Well-Controlled – by Lowest Level Treatment Required to Maintain Control* If control is achieved at: Step 1 Step 2 Then level of asthma severity is: Intermittent Mild Step 3 or 4 Persistent Moderate Step 5 or 6 Severe *See Tables 1, 2, 3. Notes: • For characterization of a patient's overall asthma severity after control is achieved. • See Table 2 for definitions of asthma control. • For clinical management, the focus is on monitoring level of control, not the level of severity, once treatment is established. Table 8. Control of Environmental Factors Exacerbating Asthma Indoors Outdoors Reduce exposure to indoor allergens and irritants: > Nonsmoking environment* > "True" (or "absolute") HEPA filters in air conditioner, forced-air heater and vacuum cleaner changed monthly > Animal dander: ▶ Remove animals; if not possible, keep out of patient's bedroom; keep door closed > Minimize indoor molds: ▶ Fix all leaks, eliminate water sources associated with mold growth ▶ Clean moldy surfaces with disinfectant or 10% bleach solution ▶ Dehumidify basements, if possible > Minimize house-dust mites: ▶ Encase pillows and mattresses with allergen- proof plastic, or ▶ Wash bed linen in hot water (> 130°F, > 60°C), remove plush toys and rugs, damp-clean furniture (caution with > 100°F, > 38°C water around children) ▶ Remove carpets from bedroom and carpets laid on concrete; minimize number of stuffed toys in patient's bedroom — wash weekly in hot water ▶ Avoid sleeping or lying on upholstered furniture > Cockroaches: use poison bait or traps (preferably not volatile chemical agents); do not leave food or garbage exposed > Keep windows closed; use air conditioning when possible *Patients with asthma who smoke should be encouraged to quit and offered counseling. 8 > Minimize or avoid exertion or exercise outside when pollution levels or pollen counts are high > Avoid environmental smoke > Keep vehicle windows closed > Avoid drying wash outside > Wear filter mask while mowing or gardening > Wear glasses or sunglasses to reduce pollen irritation > Stay inside during peak pollen counts and environmental fumes; keep air conditioners on Workplace > Suspect occupational asthma in adults with new-onset asthma > If occupational asthma confirmed, minimize/eliminate exposure to causative factor(s) where possible ▶ Work with onsite healthcare providers or managers/supervisors ▶ Discuss avoidance, ventilation, respiratory protection, nonsmoking environment > Complete cessation of exposure to initiating agents (recommended)

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