ABIM Exam Review Practice Question of the Week: Asthma Staging and Therapy

In which of the following clinical scenarios would you use a low- to medium-dose inhaled steroid and a long-acting beta 2 agonist to treat a patient’s asthma?

A. A patient having symptoms daily in the daytime, greater than five episodes per month at night and FEV₁ of 65%

B. A patient having continuous symptoms daily, frequently at night and FEV₁ of 55%

C. A patient having an acute asthma exacerbation

D. A patient with daytime symptoms greater than two times per week and at night greater than two times per month with FEV₁ of 80%

E. A patient with daytime symptoms less than two times per week and at night less than two times per month with FEV₁ of 80%

ABIM Exam Review Question Explanation

Asthma is broken down into intermittent, mild persistent, moderate persistent and severe persistent. In order to distinguish these four categories, we analyze the degree of daytime symptoms, nighttime symptoms, and FEV₁ measurement on pulmonary function tests.

Intermittent asthma is defined as having either daytime symptoms less than 2 times/week or nighttime symptoms less than 2 times/month. The FEV₁ here tends to be greater than 80%.
Mild persistent asthma is defined as having either daytime symptoms greater than 2 times/week, but not daily, or greater than 2 nighttime awakening episodes per month. The FEV₁ here also tends to be greater than 80%.
Moderate persistent asthma is defined as having either daily daytime symptoms or nighttime symptoms greater than five episodes per month. The FEV1 here tends to be between 60-80%.
Severe persistent asthma is defined as having either continuous daytime symptoms or frequent nighttime symptoms. The FEV1 here tends to be less than 60%.

Treatment options for asthma are dependent on the patient’s asthma stage:

Intermittent: Requires short-acting β2 agonists as needed, which is a part of the treatment for all levels of asthma.
Mild persistent: Requires low-dose inhaled corticosteroids or leukotriene inhibitors or theophylline.
Moderate persistent: Requires low- to medium-dose inhaled corticosteroids and long-acting β2 agonists.
Severe persistent: Requires high-dose inhaled steroids, long-acting β2 agonists and tapering of oral steroids.

Now that we know this categorization, we identify that treatment with low- to medium-dose inhaled steroids and a long-acting beta 2 agonist corresponds to moderate persistent asthma. Which scenario points to this diagnosis?

Only the patient in Choice A (Patient having symptoms daily in the daytime, greater than five episodes per month at night and FEV₁ of 65%) would fall under this categorization.

Going through the other answer choices:

Choice B (Continuous symptoms daily, frequently at night and FEV₁ of 55%) describes a patient with severe persistent asthma who usually has FEV₁ less than 60%
Choice D (Daytime symptoms greater than two times per week and at night greater than two times per month with FEV₁ of 80%) describes a patient with mild persistent asthma
Choice E (Daytime symptoms less than two times per week and at night less than two times per month with FEV₁ of 80%) describes a patient with intermittent asthma

You can view all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.