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Pulmonary NAEPP / GINA

Asthma

🔬 Severity Classification (Before Treatment)
SeveritySymptomsNight AwakeningsSABA UseFEV1Exacerbations/yr
Intermittent≤2 days/week≤2x/month≤2 days/week≥80%0-1
Mild Persistent>2 days/week, not daily3-4x/month>2 days/week≥80%≥2
Moderate PersistentDaily>1x/weekDaily60-80%≥2
Severe PersistentThroughout the dayOften nightlyMultiple times/day<60%≥2
📈 NAEPP Stepwise Treatment
1
Intermittent: PRN SABA only (albuterol). No daily controller needed.
2
Mild Persistent: Low-dose ICS (preferred) OR LTRA (montelukast) or cromolyn daily + PRN SABA
3
Moderate Persistent: Low-dose ICS + LABA OR medium-dose ICS + PRN SABA
4
Moderate-Severe: Medium-dose ICS + LABA (preferred) + PRN SABA
5
Severe: High-dose ICS + LABA + consider omalizumab (allergic) or mepolizumab (eosinophilic)
6
Refractory Severe: Step 5 + oral corticosteroids (lowest effective dose)
💊 Key Drug Classes
ClassExamplesUse
SABAAlbuterol, LevalbuterolRescue - quick relief
ICSFluticasone, Budesonide, BeclomethasoneController - first line
LABASalmeterol, FormoterolAdd-on to ICS (never alone)
LTRAMontelukast, ZafirlukastAlternative controller or add-on
LAMATiotropiumAdd-on for severe uncontrolled
BiologicsOmalizumab (anti-IgE), Mepolizumab (anti-IL5)Severe allergic/eosinophilic
Oral CSPrednisoneExacerbations or refractory
🚨 Acute Exacerbation Management
Admit if: FEV1 or PEF <40% predicted after 3 SABA treatments, poor response at 1 hour, high-risk patient, or worsening despite treatment
📊 Monitoring & Control Assessment
ParameterWell-ControlledNot Well-Controlled
Symptoms≤2 days/week>2 days/week
Nighttime awakenings≤2x/month1-3x/week
Activity limitationNoneSome
SABA use≤2 days/week>2 days/week
FEV1/PEF>80%60-80%
Exacerbations0-1/year≥2/year
📋 Patient Education Pearls