Nguyen et al developed a severity classification for adults with asthma based on the recommendations of the 1991 National Asthma Education and Prevention Program (NAEPP) Expert Panel.
Patient data:
(1) medication use over past year
(2) evening and morning peak expiratory flow rates (PEFR) in L per min
(3) predicted PEFR in L per min
Parameters:
(1) mean evening peak expiratory flow rate (PEFR) as percent of predicted PEFR
(2) maximum diurnal variation over a 2 week period
(3) medication history
mean evening PEFR as percent of predicted PEFR =
= (mean evening PEFR in L/min) / (predicted PEFR in L/min) * 100%
diurnal variation =
= ((evening PEFR in L/min) – (next morning PEFR in L/min)) / (evening PEFR in L/min) * 100%
|
Medications As Needed |
Daily Medications |
Oral Steroids |
Points |
|
none |
none |
none |
0 |
|
1 medication |
none |
none |
1 |
|
> 1 medication |
none |
none |
2 |
|
1 medication |
1 medication |
none |
3 |
|
> 1 medication |
1 medication |
none |
4 |
|
|
2-3 medications |
none |
5 |
|
|
4-5 medications |
none |
6 |
|
|
|
used as needed |
7 |
|
|
|
> 1 short course at any time in the past year |
7 |
|
|
|
every other day spanning > 14 days in last year |
8 |
|
|
|
daily spanning > 14 days in the last year |
9 |
where:
• A short course of steroids indicates either (a) oral steroids for 3-14 days, or (b) a single injection of slowly-released steroid agent.
|
Parameter |
Finding |
Points |
|
mean evening PEFR as percent predicted PEFR |
> 80% |
1 |
|
|
60 – 80% |
2 |
|
|
< 60% |
3 |
|
maximum diurnal variation in PEFR |
mild, < 20% ("nondipper") |
1 |
|
|
moderate, 20 – 29% ("dipper") |
2 |
|
|
severe, >= 30% ("severe dipper") |
3 |
|
medication use |
medication score 0, 1, or 2 |
1 |
|
|
medication score 3, 4, 5 or 6 |
2 |
|
|
medication score 7 with <= 3 short bursts of steroids in past year |
2 |
|
|
medication score 7 with > 3 short bursts of steroids in past year |
3 |
|
|
medication score 8 or 9 |
3 |
severity score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 9
• The higher the score the more severe the asthma.
|
Score |
Asthma Severity |
|
3 or 4 |
mild |
|
5 or 6 |
moderate |
|
7, 8 or 9 |
severe |
Specialty: Pulmonology
