Asthma Classifications

Once you have received your asthma diagnosis you will then be given an asthma severity classification. There are different types of asthma, such as allergic and non allergic, but classifying asthma severity goes beyond that. I’ve said before and I’ll say it again, asthma is not a one size its all disease. The EPR-3 (Expert Panel Report 3) guideline classifications divides asthma severity into four different groups: intermittent, mild persistent, moderate persistent, and severe persistent.

Intermittent Asthma

If you are having symptoms less than 2 days a week needing your rescue inhaler less than two times a week, and do not need a daily controller (steroid) medication to control your asthma, it is classified as intermittent. Nighttime awakenings are less than two nights a month, and there is no interference with normal activity. This is the mildest classification of asthma. Lung function testing will often show normal FEV1 (forced expiratory volume in the first second) between asthma flare ups.

Mild Persistent Asthma

If your asthma symptoms are occurring more than two days per week but not daily, and you are needing your rescue inhaler more than 2 days a week (but not daily), you will fall into the mild persistent classification. Nighttime awakenings are three to four times a month, with minor limitations to daily activities. Lung function will show a FEV1 of greater than or equal to 80% predicted. In this classification you will more than likely be on a daily low dose controller/steroid inhaler.

Moderate Persistent Asthma

Asthma symptoms are experienced daily, and you are finding that you need your rescue inhaler daily. Nighttime awakenings due to asthma occur more than once per week but not nightly. You will have increased limitation with normal activity, but not extreme. Lung function will show FEV1 between 60% and 80% predicted. A daily combination steroid/LABA (long acting beta agonist) medication is used in this classification and in some cases, more than one is needed to keep asthma in control. Seeing either an asthma specialist or Pulmonologist would be a good idea to better manage your disease.

Severe Persistent Asthma

This is the most severe category that clinicians use when classifying asthma. Here, asthmatics will have asthma symptoms throughout the day every day, needing to use their rescue inhaler multiple times per day. Every day activities are very difficult and there are extreme limitations. Lung function will show a FEV1 less than 60% predicted. You will more than likely be followed by an asthma specialist or Pulmonologist in this classification and be maxed out on multiple daily asthma medications and might need a daily oral steroid (such as prednisone) to keep breathing.

There are also classifications to assess asthma control. You might have heard of the Asthma Control Test or the ACT. Often times doctors (more specifically asthma/allergy doctors and pulmonologists) will have asthma patients fill one out at each visit, as asthma severity and control can change over time. The scores from these questionnaires (such as the ACT) can be used to categorize asthma into three control categories: well controlled, not well controlled, and very poorly controlled.

Which asthma classification do you fall into?