Moderate persistent asthma REF: Nelson's pediatrics 17th ed page 767 CLASSIFICATION OF CHILDHOOD ASTHMA: Asthma Days with Nights Lung Long-Term-Control Medication Quick? Severity Symptoms with Function Relief Medication Symptoms Step 1: Mild <3 per week <3 per FEV1 or PEF No daily medication Sho-acting g-agonist Intermittent month =80% of predicted; PEF variability <20% needed as needed and before exercise; Use =3 times per wk may indicate need to initiate long? term-control therapy Step 2: Mild =3 per week 3-4 per FEV1 or PEF Anti-inflammatory: Sho-acting g-agonist Persistent month =80% of predicted; PEF variability 20-30% either low-dose inhaled glucocoicoid, cromolyn, nedocromil, or leukotriene modifier. as needed and before exercise; daily use or increasing use may indicate need for additional long-term? control therapy Sustained-release theophylline is an alternative Step 3: Moderate Persistent Daily symptoms daily use of sho-acting A-agonists >1 time per week FEV1 or PEF >60 and =80% of predicted; PEF variability >30% Anti-inflammatory: inhaled lucocoicoids (medium-dose) or inhaled glucocoicoids (low-dose) and either long-acting S-agonist Sho-acting S-agonist as needed and before exercise; daily use or increasing use may indicate need for additional long-term? control therapy (LABA), leukotriene modifier, sustained? release theophylline, or LABA tablets. Step 4: Continual Frequent FEV1 or Anti-inflammatory: Oral glucocoicoid if Severe Persistent symptoms, limited PEF =60% of inhaled glucocoicoids (high- needed. Sho-acting 8-agonist physical predicted; dose) and long-acting as needed and before activity, frequent PEF variability bronchodilator: either LABA, leukotriene exercise; daily use or increasing use may exacerbations >30% modifier, sustained- release theophylline, and/or LABA tablets. indicate need for additional long-term? control therapy