What is the classification of asthma in a patient with a recent asthma attack 1 month prior, who typically does not use albuterol (bronchodilator) or a control inhaler regularly?

Asthma Classification: Intermittent Asthma

This patient has intermittent asthma based on the single exacerbation within the past year and minimal to no regular medication use. 1

Classification Rationale

According to the NAEPP Expert Panel Report 3 (EPR-3) guidelines, asthma severity is determined by assessing both impairment (day-to-day symptoms and functional limitations) and risk (likelihood of future exacerbations). 1 The classification is assigned to the most severe category in which any feature occurs. 1

Key Classification Criteria for This Patient:

Risk Domain - Exacerbations:

• 0-1 exacerbations per year requiring oral systemic corticosteroids = Intermittent asthma 1
• This patient had 1 attack one month ago, placing them in the intermittent category based on risk assessment 1

Impairment Domain - Medication Use:

• The patient does not use albuterol regularly or frequently (≤2 days per week for symptom control) 1
• No regular controller medication use suggests minimal day-to-day symptoms 1
• These features are consistent with intermittent asthma: symptoms ≤2 days per week, nighttime awakenings ≤2 times per month, and no interference with normal activity 1

Critical Guideline Distinction

The EPR-3 guidelines specifically state that patients with ≥2 exacerbations requiring oral systemic corticosteroids in the past year should be considered to have persistent asthma, even if all impairment features suggest intermittent disease. 1 Since this patient had only 1 exacerbation, they do not meet this threshold for automatic reclassification to persistent asthma. 1

Important Clinical Caveats

Verify the complete clinical picture before finalizing classification:

• Confirm the patient truly has minimal symptoms (≤2 days/week) and not just poor symptom recognition 1
• Assess whether the recent attack was truly isolated or part of a pattern of worsening control 1
• Determine if the patient is underusing medications due to good control versus poor access, adherence, or symptom perception 1

If any of the following are present, reclassification to persistent asthma may be warranted:

• Symptoms >2 days per week 1
• Nighttime awakenings 3-4 times per month or more 1
• Any limitation of normal activities due to asthma 1
• FEV₁ <80% predicted or FEV₁/FVC ratio reduced >5% 1

Patients and physicians commonly underestimate asthma severity—39-70% of patients with moderate symptoms believe their asthma is well-controlled. 1 Therefore, systematic assessment using objective criteria rather than patient perception alone is essential. 1