From the Guidelines
Asthma is classified into four stages based on severity: intermittent, mild persistent, moderate persistent, and severe persistent.
Asthma Classification
The classification of asthma severity is based on the frequency of symptoms, the impact of symptoms on daily activities, and the risk of future exacerbations 1.
- Intermittent asthma involves symptoms occurring less than twice a week, with brief exacerbations and nighttime symptoms less than twice a month.
- Mild persistent asthma presents with symptoms more than twice weekly but not daily, with exacerbations affecting activity and sleep, and nighttime symptoms more than twice monthly.
- Moderate persistent asthma features daily symptoms, exacerbations at least twice weekly affecting activity and sleep, and nighttime symptoms more than once weekly.
- Severe persistent asthma involves continuous symptoms, frequent exacerbations, limited physical activity, and frequent nighttime symptoms.
Treatment Approach
Treatment typically progresses from as-needed short-acting beta-agonists (like albuterol) for intermittent asthma to daily low-dose inhaled corticosteroids (like fluticasone) for mild persistent, medium-dose inhaled corticosteroids plus long-acting beta-agonists (like salmeterol) for moderate persistent, and high-dose inhaled corticosteroids with long-acting beta-agonists and possibly biologics (like omalizumab) for severe persistent asthma 1. This classification system helps healthcare providers determine appropriate treatment plans based on symptom frequency, severity, and impact on daily activities, with the goal of achieving good asthma control while minimizing medication side effects. The assessment of asthma control should include evaluation of symptoms, lung function, and the frequency and severity of exacerbations, as well as consideration of the patient's quality of life and ability to participate in daily activities 1.
From the Research
Asthma Stages/Severities
Asthma can be classified into different stages or severities, which are important for determining the appropriate treatment and management plan. The following are the different stages/severities of asthma:
- Intermittent asthma: characterized by mild symptoms that occur less frequently 2, 3, 4, 5
- Mild persistent asthma: characterized by mild symptoms that occur more frequently than intermittent asthma 2, 3, 4, 5
- Moderate persistent asthma: characterized by moderate symptoms that occur regularly 2, 3, 4, 5
- Severe persistent asthma: characterized by severe symptoms that occur frequently and can be life-threatening 2, 3, 4, 5
Classification of Asthma Exacerbations
Asthma exacerbations can also be classified into different severities, including:
- Mild exacerbation: characterized by a peak expiratory flow of 80% or more of the patient's personal best 6
- Moderate exacerbation: characterized by a peak expiratory flow of 50-79% of the patient's personal best 6
- Severe exacerbation: characterized by a peak expiratory flow of less than 50% of the patient's personal best 6
- Life-threatening exacerbation: characterized by severe symptoms, such as respiratory failure, and requires immediate medical attention 6
Other Classifications of Asthma
Asthma can also be classified into other types, including:
- Allergic asthma: triggered by allergens such as dust, pollen, or pet dander 3, 5
- Nonallergic asthma: triggered by viral upper respiratory tract infections or no apparent cause 3, 5
- Occupational asthma: triggered by workplace exposures 3, 5
- Aspirin-exacerbated respiratory disease: triggered by aspirin or other nonsteroidal anti-inflammatory drugs 3, 5
- Cough variant asthma: characterized by a nonproductive cough that responds to treatment for asthma but not with antibiotics or other treatments 3, 5