Some patients with uncontrolled asthma have actual changes in the structure of the airways that can result in persistent airflow limitation. Adequate treatment may prevent long-term damage. Although asthma does not come labeled with predetermined levels of severity, such designations can be useful to the physician and patients in assessing progress or determining the need for changes in management or emergency intervention. The guidelines divide asthma into categories of mild intermittent, mild persistent, moderate persistent and severe persistent. This is much easier than trying to decide how many emergency department visits should occur before you switch the patient to daily therapy.
Aggressive management is recommended early in the course of an exacerbation.
This expert opinion, although not based on evidence, may sanction family physicians' freedom to use steroids or nebulizer therapy early in the course of treatment. Factors contributing to asthma should be evaluated and controlled when possible. Exposure to tobacco smoke, seasonal allergens and environmental factors may all require life-style modification to control asthma. It is good to see the basic tenets of our specialty confirmed by the panel of primarily subspecialty experts. In summary, the guidelines are not to be used as if they were written in stone or deserved to be written in stone.