Classifying asthma severity and initiating treatment in children 0 to 4 years of age

Assessing severity and initiating therapy in children who are not currently taking long-term control medication. The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs. Level of severity is determined by both impairment and risk. Assess impairment domain by patient's/caregiver's recall of previous 2 to 4 weeks. Symptom assessment for longer periods should reflect a global assessment, such as inquiring whether the patient's asthma is better or worse since the last visit. Assign severity to the most severe category in which any feature occurs. At present, data are inadequate to correlate frequencies of exacerbations with different levels of asthma severity. For treatment purposes, patients who had ≥2 exacerbations requiring oral systemic glucocorticoids in the past 6 months, or ≥4 wheezing episodes in the past year, and who have risk factors for persistent asthma may be considered the same as patients who have persistent asthma, even in the absence of impairment levels consistent with persistent asthma.