Challenges in assessing asthma severity in clinical practice

Joseph Spahn, William J. Calhoun

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


The National Heart, Lung, and Blood Institute's 1997 National Asthma Education and Prevention Program (NAEPP) classifies asthma severity on the basis of lung function and symptoms, and most clinicians use either or both of these measures to assess patients. Severity-based stratification of patients provides a useful framework for therapeutic decision making, but this approach should not be adopted without an understanding of its delimitations and challenges. Accurate assessment of asthma severity is crucial in ensuring the patient's health and well-being. The consequences of misappraisal of patients' clinical status include unnecessary prescription of medication when severity is overestimated and failure to intervene with resulting deterioration of asthma control - possibly culminating in death - when severity is underestimated. This review reveals that applying the NAEPP's severity-based classification of patients with asthma in clinical practice can be challenging, particularly in the care of patients at the mild end of the asthma severity continuum. The variable nature of asthma, the poor concordance among measures of asthma severity, and patients' tendency to under-report their asthma symptoms can contribute to inaccurate severity assessments, which can lead to inappropriate therapeutic choices, such as undertreatment. Under-treatment of the patient with mild asthma can be as dangerous as under-treatment of patients with more severe disease. By keeping the challenges associated with severity-based stratification of patients top-of-mind, healthcare providers may be better able to overcome them in clinical practice.

Original languageEnglish (US)
Pages (from-to)S372-S378
JournalAdvanced Studies in Medicine
Issue number5 A
StatePublished - May 2003
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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