1. 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

2. 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

3. 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.)

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

5. 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.