Of all chronic (long-term) childhood diseases in the U.S., asthma is the most common. To help guide the management of this disease, 15 years ago the National Asthma Education and Prevention Program (NAEPP) created a system to classify asthma according to severity. This classification system is based on the frequency of daytime and nighttime symptoms and the degree to which the symptoms interfere with the person’s daily activities.

Researchers in Wisconsin recently measured the accuracy of the NAEPP classification system in evaluating children brought to a hospital’s emergency department. The researchers studied 750 children younger than 18 who were being treated for an asthma flare.

The children were classified as having 1 of 4 levels of asthma: mild intermittent, mild persistent, moderate persistent, or severe persistent. These assignments were made using 3 different methods:

• the standard NAEPP method, which relied solely on the child’s or parent’s report of how frequently symptoms occurred
• the modified NAEPP method, which took into account both symptom frequency and the child’s or parent’s report of how much controller medication the child used
• the additive modified method, in which the researchers assigned numerical values to symptom frequency and controller-medication use so that they could calculate a score of asthma severity.

A quality-of-life score specifically related to asthma was measured as well, as were the number of the child’s hospital admissions and emergency department visits.

Many reclassified as methods changed

Using the standard classification method, it appeared that 55% of the children had mild intermittent asthma; 21% had mild persistent asthma; 14%, moderate persistent asthma; and 10%, severe persistent asthma.

However, when the use of controller medications was accounted for (in the modified method of rating asthma severity) 22% of children who had been classified as having mild intermittent asthma by symptoms alone were now in the persistent-asthma category. With all 3 scoring methods, the quality of-life scores fell significantly as the level of asthma severity increased.

All things (should be) considered

The standard NAEPP asthma severity classification method is a simple way for doctors to evaluate asthma severity. And, the researchers believe that it should continue to be used, especially for quick evaluations in the emergency department or other outpatient settings.

The researchers state, however, that health-related quality-of-life scores, number of hospital admissions, and number of visits to the emergency department are also part of the overall story of the burden of asthma in children.

From Pediatrics