Diagnosing and Staging Asthma* Cyril Grum, M.D. Department of Internal Medicine *Based on the University of Michigan Guidelines for Clinic Care and the National Asthma Education and Prevention Progam (NAEPP) 2002 Update

First, make the correct diagnosis Elements of a diagnosis of asthma: episodic symptoms of airway obstruction present airflow obstruction present and is at least partially reversible alternative diagnoses excluded

Symptoms suggesting asthma Cough An attack, or recurrent attacks, of wheezing Shortness of breath or chest tightness Nocturnal cough Exercise-induced cough or wheezing Onset of symptoms after exposure to airborne allergens or other stimuli History of persistent respiratory tract infections Conditions associated with asthma (e.g., nasal polyps, rhinitis, atopic dermatitis, etc.)

Classification by asthma severity (from MMWR March 28, 2003 / 52(RR06);1-8) Refer to document “Normal PEF tables.pdf” for normal values

Home monitoring of Peak Expiratory Flow (PEF) Green Zone (80-100% of personal best) “all clear” no change in therapy; if asymptomatic for a prolonged period, consider reduction in medication with monitoring. Yellow Zone (50-80% of personal best) “caution” suboptimal control or early exacerbation. Red Zone (< 50% of personal best) “alert” initiate more intense treatment , often a course of steroids.