Related Experiment Video
Updated: Aug 7, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
National Asthma Education and Prevention Program severity classification as a measure of disease burden in children
Maria Y Kwok1, Christine M Walsh-Kelly, Marc H Gorelick
1Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
The National Asthma Education and Prevention Program (NAEPP) severity classification for childhood asthma is insufficient alone. Accounting for controller medication use provides a more complete picture of a child's asthma burden.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Public Health
Background:
- Asthma is a significant chronic respiratory disease in children.
- Accurate assessment of asthma severity is crucial for effective management.
- The National Asthma Education and Prevention Program (NAEPP) provides guidelines for asthma classification.
Purpose of the Study:
- To evaluate the association between NAEPP asthma severity classification and other indicators of disease burden in children.
- To determine if NAEPP classification alone adequately reflects the overall impact of asthma on children's lives.
Main Methods:
- A cross-sectional study involving 750 children under 18 with physician-diagnosed asthma.
- Asthma severity was classified using three methods: symptom frequency alone, symptom frequency plus controller medication use, and a scored additive method.
- Asthma burden was measured using the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF) quality-of-life score and the number of emergency department visits and hospital admissions.
Main Results:
- The standard NAEPP classification based on symptoms alone identified 55% of children with mild intermittent asthma.
- When controller medication use was considered, 22% of children initially classified as mild intermittent were reclassified as persistent asthma.
- While quality-of-life scores and healthcare utilization decreased with increasing severity, the association was modest, indicating limitations in the classification's predictive power.
Conclusions:
- The NAEPP severity classification, when used alone, offers an incomplete assessment of the disease burden in children with acute asthma.
- Incorporating controller medication use into asthma severity assessments provides a more comprehensive understanding of the child's condition.
- Further refinement of asthma classification tools is needed to fully capture the multifaceted burden of childhood asthma.
Objective:
To examine the association between the National Asthma Education and Prevention Program (NAEPP) severity classification and other measures of burden of disease in children with acute asthma.
Methods:
We performed a cross-sectional study of 750 children <18 years of age with a physician diagnosis of asthma and treated in an emergency department (ED) for acute asthma exacerbation. Subjects were assigned to 1 of 4 levels of severity (mild intermittent, mild persistent, moderate persistent, or severe persistent). Assignments followed 3 methods: the report of symptom frequency alone (standard method); symptom frequency and reported controller-medication use (modified method); or the additive modified method in which the symptom frequency and reported controller-medication use were assigned numeric values and a score was calculated. An asthma-specific quality-of-life score was calculated by using the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF). The number of ED visits and hospital admissions for asthma over the previous 12 months was collected also. Differences between severity groups were compared with analysis of variance, and the proportion of variance explained (r2) was calculated.
Results:
Using the standard classification method, 55% of subjects had mild intermittent asthma, 21% had mild persistent asthma, 14% had moderate persistent asthma, and 10% had severe persistent asthma. Among those classified as having mild intermittent asthma by symptoms alone, 22% were reclassified as having persistent asthma when controller medications were accounted for. With all 3 scoring methods, mean ITG-CASF scores decreased significantly with each increasing level of severity. However, the magnitude of this association was modest. There was a significant but limited association between severity level and mean number of ED visits and hospitalizations.
Conclusion:
NAEPP severity classification alone provides an incomplete picture of the burden of disease in children with asthma.
Related Concept Videos
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:30Asthma-IV: Nursing Management
First, in...
01:28Asthma I: Introduction
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:29Asthma-I: Introduction