Understanding Asthma Classification

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Asthma classification is an important part of your asthma care plan. By categorizing your asthma, you can get an idea of your asthma control. You can also take specific steps to improve your asthma.

Your asthma classification will change over time. There are a number of different ways you can think about your asthma classification.

Asthma Severity

Asthma severity describes an intrinsic intensity of your asthma. The table below outlines several different ways to look at asthma severity.

Your doctor will generally place you into one of the following asthma classifications based on your worst symptoms. For example, if most of your symptoms are “Mild Persistent” but you have one symptom that is in “Moderate Persistent,” you will be classified as “Moderate Persistent.” The different asthma severity classifications based on the NHLBI Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma include:

  • Intermittent
  • Mild Persistent
  • Moderate Persistent
  • Severe Persistent

In order to be able to provide you an asthma classification, your doctor will need to ask you a number of different questions. Some questions might include:

  • How many days per week do you experience asthma symptoms?
  • How many nights per week does your asthma wake you up?
  • How often do you need to use your rescue inhaler?
  • Does your asthma interfere with your regular activities?

Answers to these questions will help your doctor determine your asthma classification.

Asthma Symptoms

Symptoms are another important part of your asthma classification. Classic asthma symptoms include:

In general, the more symptoms you have the more severe your asthma classification will be. Additionally, the following symptoms indicate poorer control and a worse asthma severity:

  • Frequent coughing at night
  • Coughing or wheezing with exercise or physical activity
  • Getting tired with activities that you would normally complete easily
  • Decreases in your peak flow
  • Restless sleep or waking up tired
  • Worsening allergy symptoms like a persistent runny nose, dark circles under your eyes or itchy, inflamed skin

Rescue Inhaler Use

Your goal should be to not need to use your rescue inhaler very often. If you are using it every day or even more than a couple of times per week, your asthma is not optimally controlled. Frequent rescue inhaler use will lead to a worsening asthma classification.

Expect your doctor to ask you questions like “How many times did you use your rescue inhaler last week?”

FEV1 and Peak Flow

Peak flow demonstrates how quickly you can blow air out of your lungs and is determined by using a peak flow meter. Doctors usually compare your number now to your personal best.

Forced expiratory volume is the maximal amount of air you can forcefully exhale. It is generally measured at one second (FEV1) and used to be only available in a specialist’s office. Now it is available in some home pocket spirometers.

While there is some debate as to whether asthma classification and treatment should be based on the hard numbers these devices produce, or off your symptoms, much of that depends on you. Additionally, there is also no reason why you could not base your asthma action plan off of numbers from these devices for 3 months and then repeat using an asthma action plan for symptoms for the next 3 months. You can then see which one you think leads to better overall control of your asthma.

Final Thoughts

How you and your doctor choose to classify your asthma in the long term probably matters less than making sure you know your asthma classification (however you and your doctor define) and how it affects your treatment.

If you are not familiar with your asthma classification and are not able to take specific actions based on it, talk to your doctor soon about what your asthma classification is and what you need to do to get your asthma under control.

Asthma Severity

Intermittent Mild Persistent Moderate Persistent Severe Persistent
Symptoms 2 or less days per week More than 2 days per week Daily Throughout the day
Nighttime Awakenings 2 X's per month or less 3-4 X's per month More than once per week but not nightly Nightly
Rescue Inhaler Use 2 or less days per week More than 2 days per week, but not daily Daily Several times per day
Interference With Normal Activity None Minor limitation Some limitation Extremely limited
Lung Function FEV1 >80% predicted and normal between exacerbations FEV1 >80% predicted FEV1 60-80% predicted FEV1 less than 60% predicted
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