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Published ahead of print on June 1, 2004, doi:10.1164/rccm.200308-1178OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 426-432

A more recent version of this article appeared on August 15, 2004
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Submitted on August 26, 2003
Accepted on May 20, 2004

Classifying Asthma Severity in Children-Mismatch Between Symptoms, Medication Use and Lung Function

Leonard B Bacharier1*, Robert C Strunk1, David Mauger2, Deborah White1, Robert F Lemanske, Jr.3, and Christine A Sorkness4

1 Division of Allergy and Pulmonary Medicine and Department of Pediatrics, Washington University School of Medicine and St. Louis Chirldren's Hospital, St. Louis, MO, USA, 2 Department of Health Evaluation Sciences, Penn State University, Hershey, PA, USA, 3 Department of Pediatrics and Medicine, University of Wisconsin, Madison, WI, USA, 4 Department of Medicine and School of Pharmacy, University of Wisconsin, Madison, WI, USA

* To whom correspondence should be addressed. E-mail: bacharier_l{at}kids.wustl.edu.

Current guidelines for asthma care categorize asthma severity based upon the frequency of asthma symptoms, medication use, and lung function measures. The objective of this study was to determine if lung function measures are consistent with levels of asthma severity as defined by the NAEPP/EPRII Guidelines. Parents of children aged 5-18 years with asthma seen in two outpatient subspecialty clinics completed questionnaires regarding asthma medication use and symptom frequency over the preceding 1 and 4 weeks, respectively. All children performed spirometry. When asthma severity was based upon the higher severity of asthma symptom frequency or medication use, asthma was mild intermittent in 6.9% of participants, mild persistent in 27.9%, moderate persistent in 22.4%, and severe persistent in 42.9%. FEV1% predicted did not differ by level of asthma severity. FEV1/FVC decreased as asthma severity increased (p<0.0001), was abnormal in 33% of the participants, and a greater percentage of participants had an abnormal FEV1/FVC as asthma severity increased (p=0.0001). In children, asthma severity classified by symptom frequency and medication usage does not correlate with FEV1 categories defined by NAEPP Guidelines. FEV1 is generally normal, even in severe persistent childhood asthma, while FEV1/FVC declines as asthma severity increases.
Key words: Asthma, childhood, severity, pulmonary function




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