What are the classification guidelines of asthma?

Updated: Jan 07, 2019
  • Author: Michael J Morris, MD, FACP, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
  • Print
Answer

The 2007 NAEPP guidelines [1] and the 2009 VA/DoD asthma management guidelines [43] use the severity of asthma classification below, with features of asthma severity divided into three charts to reflect classification in different age groups (0-4 y, 5-11 y, and 12 y and older). Classification includes (1) intermittent asthma, (2) mild persistent asthma, (3) moderate persistent asthma, (4) and severe persistent asthma.

Intermittent asthma is characterized as follows:

  • Symptoms of cough, wheezing, chest tightness, or difficulty breathing less than twice a week
  • Flare-ups are brief, but intensity may vary
  • Nighttime symptoms less than twice a month
  • No symptoms between flare-ups
  • Lung function test FEV 1 is 80% or more above normal values
  • Peak flow has less than 20% variability am-to-am or am-to-pm, day-to-day

Mild persistent asthma is characterized as follows:

  • Symptoms of cough, wheezing, chest tightness, or difficulty breathing 3-6 times a week
  • Flare-ups may affect activity level
  • Nighttime symptoms 3-4 times a month
  • Lung function test FEV 1 is 80% or more above normal values
  • Peak flow has less than 20-30% variability

Moderate persistent asthma is characterized as follows:

  • Symptoms of cough, wheezing, chest tightness, or difficulty breathing daily
  • Flare-ups may affect activity level
  • Nighttime symptoms 5 or more times a month
  • Lung function test FEV 1 is above 60% but below 80% of normal values
  • Peak flow has more than 30% variability

Severe persistent asthma is characterized as follows:

  • Symptoms of cough, wheezing, chest tightness, or difficulty breathing that are continual
  • Frequent nighttime symptoms
  • Lung function test FEV 1 is 60% or less of normal values
  • Peak flow has more than 30% variability

In contrast, the 2016 Global Initiative for Asthma (GINA) guidelines categorize asthma severity as mild, moderate, or severe. Severity is assessed retrospectively from the level of treatment required to control symptoms and exacerbations, as follows [106] :

  • Mild asthma: Well controlled with as-needed reliever medication alone or with low-intensity controller treatment such as low-dose inhaled corticosteroids (ICSs), leukotriene receptor antagonists, or chromones
  • Moderate asthma: Well controlled with low-dose ICS/long-acting beta2-agonists (LABA)
  • Severe asthma: Requires high-dose ICS/LABA to prevent it from becoming uncontrolled, or asthma that remains uncontrolled despite this treatment

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!