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Editorials |

The Seduction of Asthma Severity Categorization

Gene L. Colice
Author and Funding Information

Affiliations: Washington, DC
 ,  Dr. Colice is Director, Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, and Professor of Medicine, The George Washington University School of Medicine. Dr. Colice has acted as a consultant for GlaxoSmithKline, Aventis, Novartis, Sepracor, Altana, Kos, Om, Schering Plough, Pfizer, Boehringer Ingelheim, and 3M pharmaceutical companies.

Correspondence to: Gene L. Colice, MD, FCCP, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010; e-mail: gxc8@mhg.edu



Chest. 2003;124(6):2054-2056. doi:10.1378/chest.124.6.2054
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The American Heritage College Dictionary, 1997

In 1997, the National Heart, Lung, and Blood Institute published the seminal and comprehensive treatise “Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma.”1 The fundamental principle guiding recommendations for asthma management in this handbook was a stepwise approach to pharmacotherapy based on a simple, clinically relevant, standardized method for classifying asthma severity. Adjusting the intensity of pharmacotherapy to the individual patient’s asthma severity seemed to be an intuitively reasonable principle, because it balanced the risks of side effects from more intensive pharmacotherapy (specifically higher doses of inhaled corticosteroids) against the potential benefits in more severe disease. There are three reasons, however, to be concerned that the method proposed in the Expert Panel Report II for classifying asthma severity is flawed. Practical observations suggest that clinicians cannot accurately use the asthma severity categorization method. The basic construct of the model is not supported by recent clinical observations. Severity categorization, as a concept, may not be as valuable as emphasizing asthma control and estimating the probability of certain poor outcomes. Given these concerns, the underlying principle of stepwise asthma pharmacotherapy based on severity categorization seems less appealing than initially suggested.

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