Treatment decisions of asthma based on a paradigm of clinical severity

The optimal treatment of asthma is amenable to modern decision analysis. One of the simplest decision models is the decision diamond. Components of the asthma decision diamond include the asthma data base, past clinical experience, latest clinical research developments, and clinical judgment. These factors are integrated into the final treatment decision. The treatment decision itself is also related to a clinical staging paradigm that can be classified into mild, moderate, and severe stages of asthma. Combined clinical and physiologic assessment determines the proper staging classification. Various treatment modalities can be used preferentially in each of the stages of asthma; these are reviewed in detail. Proper choices of pharmacologic agents at appropriate times during the natural course of asthma should be based on analytic decision making in the context of the rank order of asthma severity.