Mild Persistent Asthma

Aka: Mild Persistent Asthma, Mild Asthma

1. See Also
   1. Asthma
   2. Asthma Evaluation
   3. Asthma Education
   4. Asthma Management
   5. Mild Intermittent Asthma
   6. Moderate Persistent Asthma
   7. Severe Persistent Asthma
2. Criteria
   1. Frequent exacerbations (>2x/week) but not daily
   2. Exacerbations may affect activity
   3. Nocturnal symptoms more than twice per month
   4. Pulmonary Function Test Criteria
      1. FEV1 or PEF > 80% predicted
      2. PEF variability 20-30%
3. Management
   1. Long-term control with one Anti-Inflammatory medication
      1. Inhaled Corticosteroid (Low Dose)
      2. Inhaled Cromolyn or Nedocromil
      3. Do not substitute with Long-acting Beta Agonist
         1. Risks loss of Asthma control
         2. Steroids are key management of persistent Asthma
         3. Long-acting Beta Agonist is in addition to steroids
         4. Lazarus (2001) JAMA 285:2583-93
      4. Adult stable patients may taper steroids to half dose
         1. Hawkins (2003) BMJ 326:1115
   2. Short-term
      1. Rescue with beta agonist
      2. Increased use may indicate Moderate Persistent Asthma
   3. Asthma Education
      1. Consider Group education
4. Management: As needed Inhaled Corticosteroids
   1. Indications
      1. Mild Persistent Asthma well controlled on a low-dose Corticosteroid
   2. Contraindications (and reason to return back to daily Inhaled Corticosteroids)
      1. Albuterol inhaler use more than twice weekly
   3. Advantages
      1. May offer similar Asthma control with only one-half total Inhaled Corticosteroid dose
   4. Protocol
      1. Discontinue daily Inhaled Corticosteroid
      2. Use 2 puffs of the Inhaled Corticosteroid at the same time as the rescue inhaler
      3. Return to daily Inhaled Corticosteroid use if rescue inhaler used more than twice weekly
   5. References
      1. Boushey (2005) N Engl J Med 352(15):1519-28
      2. Martinez (2011) Lancet 377(9766):650-7
      3. Papi (2007) N Engl J Med 356(20):2040-52
5. References
   1. (1997) Management of Asthma, NIH 97-4053
   2. (1995) Global Strategy for Asthma, NIH 95-3659
   3. Kalister (2001) West J Med 174:415-20
   4. Kemp (2001) Am Fam Physician 63(7):1341-54