• symptoms or episodes occur less than once a week
• episodes/exacerbations are short, lasting only a few hours.
• smptoms are present at night no more frequently than twice per month
• PFTs are normal between episodes
• During Episodes/exacerbations, FEV1 or PEF is at least 80% of normal

• no daily drugs needed
• use of short-acting inhaled beta agonist during episodes (rescue inhaler)
• increased use of rescue inhaler more than 2 days per week indicates the need to start the next step in long-term therapy

• symptoms or episodes occur more than once per week but not daily
• symptoms are present at night more than twice per month
• episodes/exacerbations affect activity and sleep
• during episodes/exacerbations, FEV1 or PEF is at least 80% of normal
• PEF or FEV1 variability is 20-30%

• use of a daily anti-inflammatory (inhaled cortiosteroid low dose)
• use of a rescue inhaler for relief during episodes
• increased use of rescue inhaler more than 2 days per week indicates the need to start the next step in long-term therapy

symptoms occur daily

episodes/exacerbations affect activity and sleep

symptoms are present at tnight more than once per week

during episodes/exacerbations, FEV2 or PEF is only 60-80% of normal

PEF or FEV1 variability is greater than 30%

• add a daily long-acting beta agonist to low-dose ICS
• or continue ICS alone but increase to medium-dose range
• or add a Leukotriene receptor antagonist, Theophylline, or Zileuton to low dose ICS
• Increased use of rescue inhaler more than 2 days per week indicates the need to startthe next step in long-term therapy

symptoms occur daily

episodes/exacerbations are frequent

symptoms are present at night frequently.

activities are limited

during episodes/exacerbations, FEV or PEF <60%

PEF or FEV1 variability is greater than 30%

forced expiratory volume in the first second

FEV1

Peak Expiratory Flow

PEF