A. Level of asthma symptom control | |||||
In the past 4 weeks, has the patient had: | Well controlled | Partly controlled | Uncontrolled | ||
Daytime symptoms more than twice/week? | Yes | No | None of these | 1 to 2 of these | 3 to 4 of these |
Any night waking due to asthma? | Yes | No | |||
SABA reliever* needed more than twice/week? | Yes | No | |||
Any activity limitation due to asthma? | Yes | No | |||
B. Risk factors for poor asthma outcomes | |||||
Assess risk factors at diagnosis and periodically, at least every 1 to 2 years, particularly for patients experiencing exacerbations. Measure FEV1 at start of treatment, after 3 to 6 months of controller treatment to record personal best lung function, then periodically for ongoing risk assessment. | |||||
Having uncontrolled asthma symptoms is an important risk factor for exacerbations. Additional potentially modifiable risk factors for exacerbations, even in patients with few asthma symptoms, include:
Other major independent risk factors for flare-ups (exacerbations) include:
| Having any of these risk factors increases the patient's risk of exacerbations even if they have few asthma symptoms. | ||||
Risk factors for developing fixed airflow limitation include preterm birth, low birth weight, and greater infant weight gain; lack of ICS treatment; exposure to tobacco smoke, noxious chemicals, or occupational exposures; low FEV1; chronic mucus hypersecretion; and sputum or blood eosinophilia | |||||
Risk factors for medication side-effects include:
|
FEV1: forced expiratory volume in one second; ICS: inhaled corticosteroids; SABA: short-acting beta-2 agonist; FENO: fraction of expired nitric oxide; OCS: oral corticosteroid.
* The threshold of two uses per week as a measure of poor control is only appropriate for SABA relievers. Use of anti-inflammatory relievers (eg low-dose ICS-formoterol or ICS-SABA) provides additional ICS therapy and leads to lower risk of subsequent exacerbation than increased SABA alone. However, average weekly use of anti-inflammatory reliever should still be assessed when reviewing need for or dosing of maintenance ICS.
¶ Current guidelines note that use of ≥3 200-dose SABA canisters/year is also associated with increased exacerbation risk.
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