Asthma Severity Classification

Initiating the correct step of therapy at first asthma diagnosis based on severity classification.. This application is commonly used by professionals who need precise quantitative analysis to support decision-making, budgeting, and strategic planning in their respective fields

Step-up decision-making when a patient reports uncontrolled symptoms at a medication review appointment.. Industry practitioners rely on this calculation to benchmark performance, compare alternatives, and ensure compliance with established standards and regulatory requirements

Biologic therapy eligibility assessment: confirming Step 4–5 severity and eosinophilic/allergic phenotype for funding approval.. Academic researchers and students use this computation to validate theoretical models, complete coursework assignments, and develop deeper understanding of the underlying mathematical principles

Occupational health: classifying asthma severity to guide fitness-for-work assessments and workplace exposure management.. Financial analysts and planners incorporate this calculation into their workflow to produce accurate forecasts, evaluate risk scenarios, and present data-driven recommendations to stakeholders

Paediatric asthma clinics: tracking severity classification over time to guide decisions about stepping down as lung growth continues.. This application is commonly used by professionals who need precise quantitative analysis to support decision-making, budgeting, and strategic planning in their respective fields

What is the difference between asthma severity and asthma control?

Asthma severity reflects the underlying intensity of the disease process and is assessed retrospectively based on the step of treatment required to achieve control. Asthma control refers to the degree to which the manifestations of asthma are reduced or removed by treatment, assessed at each visit as well-controlled, partly controlled, or uncontrolled. A patient with severe asthma requiring Steps 4–5 may achieve good control on that treatment. Control is assessed at each visit; severity is reassessed after months of treatment.

What is the GINA Track 1 vs Track 2 approach?

GINA 2023 presents two preferred treatment tracks. Track 1 (preferred): uses low-dose ICS-formoterol as both the daily maintenance AND as-needed reliever across all steps — this 'MART' (Maintenance And Reliever Therapy) approach with budesonide-formoterol reduces severe exacerbations more effectively than SABA-based regimens. Track 2 (alternative): uses SABA as the as-needed reliever alongside ICS or ICS-LABA maintenance. Track 1 is now preferred at all steps due to superior exacerbation prevention.

When should biologics be considered for asthma?

Biologics are indicated for Step 5 severe asthma that is uncontrolled despite optimised Step 4 therapy (high-dose ICS-LABA) after confirming: good inhaler technique, adherence, no modifiable risk factors (smoking cessation, allergen avoidance), and no complicating diagnoses (vocal cord dysfunction, ABPA). Biologic selection is driven by the asthma phenotype: anti-IgE (omalizumab) for allergic asthma; anti-IL-5 (mepolizumab, reslizumab) or anti-IL-5R (benralizumab) for eosinophilic asthma (eosinophils ≥300); anti-IL-4/13R (dupilumab) for type 2 asthma with ≥300 eosinophils or FeNO ≥25.

What is a severe acute asthma attack and how is it managed?

A severe acute asthma attack is characterised by: SpO2 <92%, PEF 33–50% best/predicted, inability to complete sentences, HR >120 bpm, RR >25/min, or use of accessory muscles. Treatment: high-flow oxygen to SpO2 94–98%, nebulised salbutamol 2.5–5 mg every 20 minutes, ipratropium bromide 0.5 mg nebulised, IV or oral prednisolone 40–50 mg, and IV magnesium sulphate 1.2–2 g if no response. Life-threatening features (SpO2 <92%, silent chest, PEF <33%, confusion, cyanosis) require immediate senior review and may need NIV or invasive ventilation.

What is FeNO and how does it help in asthma?

Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation. FeNO above 40–50 ppb supports a diagnosis of eosinophilic asthma, predicts response to ICS, and identifies candidates for anti-IL-4/13 biologic therapy (dupilumab). FeNO below 25 ppb suggests non-eosinophilic asthma where increasing ICS dose is unlikely to help. FeNO is available in specialist asthma clinics and is recommended in GINA 2023 for phenotyping and biologic selection.

What triggers asthma and how can they be avoided?

Common asthma triggers include: allergens (house dust mite, pet dander, pollen, mould), respiratory infections (viral URTI — the most common exacerbation trigger in both children and adults), exercise, cold air, air pollutants (NO2, particulate matter), cigarette smoke (active and passive), aspirin/NSAIDs (in aspirin-exacerbated respiratory disease, AERD), beta-blockers, occupational exposures (flour dust, isocyanates, latex), and emotional stress. Trigger identification and avoidance are core components of asthma management.

How is childhood asthma different from adult asthma?

In children, asthma diagnosis below age 5 is more challenging because wheeze is common from viral infections ('preschool wheeze'). The diagnosis of true persistent asthma in young children requires recurrent wheezing, response to bronchodilator, family history, and eczema/allergic rhinitis. Children with asthma more often have allergic triggers (atopic asthma). A proportion of children 'outgrow' asthma at puberty, though many relapse in adulthood. ICS remain the cornerstone of controller therapy in paediatric asthma.

What is the role of peak flow monitoring in asthma?

Peak expiratory flow (PEF) monitoring provides objective, real-time measurement of large airway obstruction. A PEF diary (twice daily over 2–4 weeks) with >20% diurnal variability supports the asthma diagnosis. In acute attacks, PEF classifies severity and guides treatment decisions: PEF ≥75% = mild; 50–75% = moderate; 33–50% = severe; <33% = near-fatal. Personal best PEF (rather than predicted PEF) is more accurate for monitoring individual asthma control.