Classification of bronchial asthma

Currently, there are two main approaches to the classification of bronchial asthma: on the one hand, bronchial asthma is classified by etiology; on the other hand, by the severity of the disease.

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Severity of bronchial asthma

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Mild episodic course (intermittent asthma)

• short-term symptoms less than once a week;
• short exacerbations of the disease (from several hours to several days);
• night symptoms 2 times a month or less;
• absence of symptoms and normal respiratory function between exacerbations;
• PSV or FEV1
  • > 80% of normal;
  • daily fluctuations < 20%

Mild persistent asthma

• symptoms once a week or more often, but not every day;
• exacerbations of the disease can disrupt physical activity and sleep;
• nighttime asthma symptoms occur more than 2 times a month
• PSV or FEV1
  • > 80% of normal;
  • daily fluctuations 20-30%

Moderate persistent asthma

• daily symptoms;
• exacerbations of the disease disrupt physical activity and sleep;
• nighttime asthma symptoms occur more than once a week;
• PSV or FEV1
  • from 60 to 80% of the norm;
  • daily fluctuations > 30%

Severe persistent asthma

• persistent symptoms;
• frequent exacerbations;
• physical activity is limited by manifestations of bronchial asthma;
• PSV or FEV1
  • < 60% of normal;
  • daily fluctuations > 30%

Notes:

1. The term "symptoms" here is identical to an attack of suffocation.
2. The degree of severity should be judged only on the basis of the entire complex of the given signs and indicators of PSV and FEV.
3. The presence of even one symptom related to a more severe course of the disease allows us to assess the course of bronchial asthma as more severe.
4. PSV - peak expiratory flow rate. FEV1 - forced expiratory volume in the first second.
5. Patients with any degree of severity may develop severe exacerbations, even life-threatening ones.

The severity of bronchial asthma is assessed in a similar manner in the National Agreement of the Republic of Belarus on the Diagnosis, Prevention and Treatment of Bronchial Asthma (1998). The only difference is in the frequency of asthma attacks in mild episodic bronchial asthma (no more than 1-2 times a week) and mild persistent asthma (more than 2 times a week, but not daily).

Of great practical interest is the classification of Professor G. B. Fedoseyev (1982), which has become widely used. The advantage of the classification is the identification of stages of development of bronchial asthma and clinical and pathogenetic variants, which creates opportunities for individual diagnostics, therapy and prevention.

Classification of bronchial asthma according to ICD-10

Class X. Diseases of the respiratory system

J45	Asthma
J45.0	Predominantly allergic asthma
	Allergic bronchitis
	Allergic rhinitis with asthma
	Atopic asthma
	Exogenous allergic asthma
	Hay fever with asthma
J45.1	Non-allergic asthma
	Idiosyncratic asthma
	Endogenous non-allergic asthma
J45.8	Mixed asthma
J45.9	Unspecified asthma
	Asthmatic bronchitis
	Late onset asthma
J46	Status asthmaticus
	Acute severe asthma

The predominantly etiological principle of classification of bronchial asthma was reflected in ICD-10 (International Classification of Diseases - 10th revision), prepared by WHO in 1992.

As can be seen from the table, depending on the etiology, a distinction is made between allergic, non-allergic, mixed and unspecified asthma.

The main pathophysiological sign of bronchial asthma is the presence of bronchial hyperreactivity, which develops as a result of the inflammatory process in the bronchial wall. Hyperreactivity is an increased sensitivity of the respiratory tract to stimuli that are indifferent to healthy individuals. The degree of bronchial hyperreactivity closely correlates with the severity and prevalence of the inflammatory process and, accordingly, with the severity of bronchial asthma.

Bronchial hyperreactivity may be specific (develops in response to the effects of certain allergens) and non-specific (develops under the influence of various stimuli of a non-allergenic nature). Therefore, allergic bronchial asthma is bronchial asthma that develops under the influence of certain allergens and is characterized by specific bronchial hyperreactivity; non-allergic bronchial asthma is bronchial asthma that develops under the influence of non-allergic etiologic factors (e.g., air pollutants, industrial hazards, neuropsychiatric, endocrine disorders, physical activity, drugs, infections) and is characterized by non-specific bronchial hyperreactivity.

Mixed bronchial asthma is caused by the combined influence of allergic and non-allergic factors and is accordingly characterized by specific and non-specific bronchial hyperreactivity.

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Classification of bronchial asthma by G. B. Fedoseev (1982)

1. Stages of development of bronchial asthma
   1. Biological defects in apparently healthy people.
   2. Pre-asthma condition.
   3. Clinically expressed bronchial asthma.
2. Clinical and pathogenetic variants of bronchial asthma
   1. Atopic.
   2. Infection-dependent.
   3. Autoimmune.
   4. Glucocorticoid.
   5. Dysovarial.
   6. Severe adrenergic imbalance.
   7. Cholinergic.
   8. Neuropsychiatric.
   9. Aspirin.
   10. Primary altered bronchial reactivity.
3. Severity of bronchial asthma
   1. Light flow.
   2. Moderate severity.
   3. Severe course.
4. Phases of the course of bronchial asthma
   1. Exacerbation.
   2. Unstable remission.
   3. Remission.
   4. Persistent remission (more than 2 years).
5. Complications
   1. Pulmonary: pulmonary emphysema, atelectasis, pneumothorax, pulmonary insufficiency, etc.
   2. Extrapulmonary: pulmonary heart disease, heart failure, etc.

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