1. Evidence-Based Asthma Guidelines
J. Mark FitzGerald, MD, Dr., Sheldon Spier, MD, Dr., Pierre Ernst, MD, Dr. 
CHEST 
Volume 110, Issue 6, Pages (December 1996)
DOI: /chest
Copyright © 1996 The American College of Chest Physicians Terms and Conditions

2. FIGURE 1
Asthma continuum. (1) Assess Severity: The severity of asthma in an individual patient is judged by the frequency and chronicity of symptoms, the presence of persistent airflow limitation, and the medication required to maintain control. Signs of severe asthma include previous near-fatal episode (loss of consciousness, intubation), recent hospitalization or emergency-room visit, nighttime symptoms, limitation of daily activities, need for β2-agonists several times per day or at night, FEV1 or peak expiratory flow (PEF) less than 60% predicted. (2) Inhaled β-agonist PRN: β2-agonists should not be required daily; if used more than three times per week, institute anti-inflammatory or preventive therapy. (3) Inhaled corticosteroids: The usual dose of inhaled corticosteroids is 400 to 1,000 pg of beclomethasone, budesonide, or equivalent. Initial dose in children may be lower, ie, beclomethasone, 200 to 800 μg/day or equivalent. If asthma is mild or if control is achieved with beclomethasone less 400 pg or equivalent, a trial of cromolyn (children) or nedocromil may be warranted. (4) Additional therapy: Long-acting β2-agonists are an additional therapy for patients with unsatisfactory symptom control despite an optimal dose of inhaled steroids, particularly when there are nocturnal symptoms. In subjects who remain symptomatic despite high doses of inhaled corticosteroid therapy, theophylline improves symptoms and lung function. Reprinted with permission from Ernst et al.7
CHEST  , DOI: ( /chest )
Copyright © 1996 The American College of Chest Physicians Terms and Conditions