As you can see, your doctor may use a number of different terms to describe your asthma. Ask your doctor to explain if you don`t understand what terms they use and what they mean. Remember: Anyone can have a severe or even fatal asthma flare-up. That`s why it`s important to work with your doctor to understand your asthma and develop a management and treatment plan that`s right for you. A person, regardless of severity, can have severe asthma attacks Asthma is an inflammatory respiratory disease associated with intermittent episodes of bronchospasm.1 Bronchodilators can effectively relieve bronchospasm, but do not treat the underlying inflammation of the airways. Currently, corticosteroids are the most effective class of anti-inflammatory drugs for treating asthma. When administered in inhaled form, especially at low doses, corticosteroids act as topical anti-inflammatory agents in the respiratory tract with a low risk of systemic exposure.2 Inhaled corticosteroids have been shown to be effective in reducing airway inflammation,3,4 controlling asthma symptoms, improving lung function, reducing exacerbations,5 and hospitalization6 and mortality rates7, 8 due to asthma. However, when higher doses of inhaled corticosteroids are used, the risk of systemic exposure2 and side effects increase accordingly9. Asthma is considered moderately persistent if symptoms appear daily. Relapses occur and usually last for several days. Coughing and wheezing can disrupt a child`s normal activities and make it difficult for them to sleep. Night flare-ups can occur more than once a week.
In moderate persistent asthma, lung function is between 60% and 80% of normal without treatment. Leukotriene modifiers are considered an alternative to low-dose inhaled corticosteroids in patients with mild persistent asthma. Zafirlukast and montelukast are leukotriene receptor antagonists that selectively compete with LTD4 and LTE4 receptors. Zileuton is a 5-lipoxygenase inhibitor. Several studies have shown that these agents improve lung function while reducing symptoms and the need for short-acting beta-adrenergic agents.4 Most studies to date have been conducted in mild to moderate asthmatics, with slight improvements. Zafirlukast has been shown to attenuate the late response to bronchial hyperresponsiveness induced by allergens and postallergens.5 These classes of drugs are considered long-term control drugs and have not been used for acute exacerbations. RPR-3 recommends examining the assessment of severity and control in two areas: impairment and risk. Impairment refers to activity limitations or degree of symptoms on a daily basis.
For primary care physicians, this is the clinically relevant aspect of asthma care and an essential part of adjusting asthma treatment. In addition, the new guidelines introduce « risk » as a second parameter that should be routinely monitored in asthma patients. The risk assessment takes into account what the doctor thinks if the patient keeps their current medication. It is based on the severity and history of the asthmatic patient, as well as the likelihood of exacerbations in the coming months. With severe persistent asthma, symptoms appear daily and frequently. They also often restrict the child`s activities or disrupt sleep. Lung function is less than 60% of normal levels without treatment. Severe is the least common level of asthma. Ideally, the severity of asthma is determined before treatment is started. The classification of the EPR-3 guidelines divides the severity of asthma into four groups: intermittent, persistent-mild, persistent-moderate, and persistent-severe. The « light-intermittent » category, a classification in previous reports, has been eliminated. This term really applies only to mild diseases, and not to patients with a moderate or severe exacerbation.
A child who has symptoms of wheezing and coughing no more than 2 days a week is considered intermittent asthma; Nocturnal flare-ups occur no more than twice a month. Aside from these few episodes, a child with intermittent asthma is free of asthma symptoms. Rapid but reasonable rejuvenation of corticosteroids eliminates severe steroid toxicity; Long-term low-dose methotrexate may be an effective way to reduce the need for systemic corticosteroids in some patients with severe refractory asthma. The benefit-risk profile of inhaled corticosteroids is clearly favourable at low to medium doses. Significant benefits can be achieved with a low risk of adverse systemic effects. The use of higher doses of inhaled corticosteroids should be limited to well-defined clinical circumstances in which the expected benefit against the risk of systemic adverse reactions can be justified. The benefits of higher doses of inhaled corticosteroids can only be justified if patients with more severe asthma can be identified. Mild persistent asthma, characterized by: symptoms less than 3 days a week; nocturnal awakening 3-4 times a month; use of SABA less than 3 days a week; no activity restrictions; normal lung function between exacerbations (FEV1 80%; exacerbation 0-1 in the past year (Table 7-10). An important part of effective early treatment is a written asthma action plan for patients that guides self-management, including instructions on how to recognize signs of deterioration and warning signs when to contact the GP.
Changes in symptoms are a poor indicator of impending changes in lung function.42 Reporting of symptoms may be influenced by factors other than asthma itself. People with persistent asthma have symptoms more than twice a week.