The average person breathes about
22,000 times a day
without even thinking of it.1
But for people with asthma, it’s no casual concern.
When was your patient’s last asthma assessment? Asthma control and risk for exacerbation should be evaluated at each clinical encounter. Be sure to ask patients specifically about the severity and frequency of their symptoms. Measures of what is considered unacceptable or bothersome are subjective and will vary from person to person.2,3
Read the latest 2021 Canadian Thoracic Society Guidelines
Well-controlled asthma criteria:3
A patient who meets all of the criteria below is considered to have well-controlled asthma.
| Characteristic | Frequency or value |
|---|---|
| Daytime symptoms | ≤2 days/week |
| Nighttime symptoms | <1 night/week and mild |
| Physical activity | Normal |
| Exacerbations | Mild and infrequent* |
| Absence from work or school due to asthma | None |
| Need for a reliever (SABA or bud/form)† | ≤2 doses per week |
| FEV1 or PEF | ≥90% of personal best |
| PEF diurnal variation | <10–15%‡ |
| Sputum eosinophils | <2–3%§ |
Surveys found that 53–90% of adult Canadian patients had ≥1 criteria for poorly controlled asthma.4
Open the conversation with your patients by assessing:2,3
-
If they have had daytime asthma symptoms more than twice per week
-
If they have had any nighttime symptoms
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If they have used a SABA reliever more than twice per week
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If they have any physical activity limitations due to asthma
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If they have had any exacerbations
-
If they have been absent from work or school
-
Their FEV1 or PEF, PEF diurnal variation, and sputum eosinophils
Speak to your asthma patients today
FEV1 = forced expiratory volume in one second; PEF = peak expiratory flow; SABA = short-acting beta agonist.
- A mild exacerbation is an increase in asthma symptoms from baseline that does not require systemic steroids, an emergency department visit, or a hospitalization. “Infrequent” is not specifically defined, since the frequency of mild exacerbations that patients consider an impairment to quality of life varies. If the patient feels that the frequency of mild exacerbations is impairing their quality of life, then their asthma should be considered poorly controlled. If a patient is having frequent mild exacerbations, they should be assessed to determine if, at baseline, they have poorly controlled asthma.
- There are no established criteria for control when using bud/form as a reliever; however, use of a reliever often indicates that a patient is having symptoms and is a criterion that can be objectively assessed.
- Diurnal variation is calculated as the highest PEF minus the lowest divided by the highest peak flow multiplied by 100, for morning and night (determined over a 2-week period).
- Consider in adults ≥18 years of age with uncontrolled moderate to severe asthma who are assessed in specialist centres.
References:
- Canadian Lung Association. Breathing. Accessed April 27, 2023.
- Global Initiative for Asthma Management and Prevention. 2022 update.
- Yang CL, et al. Canadian Thoracic Society 2021 Guideline update: Diagnosis and management of asthma in preschoolers, children and adults. Can Respir J. 2021;348–361.
- Yang CL, et al. 2021 Canadian Thoracic Society Guideline – A focused update on the management of very mild and mild asthma. Can J Respir Crit. 2021;5(4):205–245.
