How Severe is My Asthma: Classifying Asthma Severity

If you or a loved one has asthma, you may hear healthcare providers use different terms or talk about classifications of the disease. This is because all asthma is not the same. Symptoms can vary from person to person.

Doctors and researchers classify most cases of asthma in four main levels:

1. Intermittent asthma
2. Mild persistent asthma
3. Moderate persistent asthma
4. Severe persistent asthma

Your level is based on the frequency and severity of your symptoms, as well as a clinical assessment and lung function test results. Testing may involve spirometry, fractional exhaled nitric oxide (FeNO), or a peak flow meter. These breathing tests provide a measurement that can be used to evaluate your asthma severity levels.

• Spirometry measures your forced expiratory volume (FEV1). It evaluates how much air you can exhale in one second during a forced breath.
• FeNO measures the level of nitric oxide in your breath. High levels of exhaled nitric oxide indicate airway inflammation.
• A peak flow meter measures your peak expiratory flow rate (PEFR). This is the maximum speed that you can force air out of your lungs. (Peak flow meters are most often used to monitor daily symptoms and assess changes in lung function over time.)

Here’s a closer look at the four main levels of asthma:

Intermittent asthma

Characteristics of intermittent asthma (also called mild asthma) include:

• asthma symptoms occur less than twice a week with short flare-ups (they come and go)
• symptoms don’t affect your daily activities
• symptoms at night no more than twice a month
• FEV1 is 80% or better
• peak flow rate varies by less than 20%

Mild persistent asthma

Characteristics of mild persistent asthma include:

• asthma symptoms 3-6 times weekly
• level of activity may be affected by flare-ups
• symptoms at night occur 3-4 times a month
• FEV1 is 80% or better
• peak flow rate varies by less than 20%

Moderate persistent asthma

Characteristics of moderate persistent asthma include:

• asthma symptoms daily
• level of activity is somewhat affected by flare-ups and symptoms
• nighttime symptoms occur 5 or more times a month
• FEV1 is between 60-80%
• peak flow rate varies by more than 30%

Severe persistent asthma

Characteristics of severe persistent asthma include:

• asthma symptoms throughout the day (uncontrolled asthma)
• level of activity is very limited by flare-ups and symptoms
• nighttime symptoms occur often
• FEV1 is 60% or less
• peak flow rate varies by more than 30%

See What is Severe Asthma?

What can affect your asthma severity?

Several factors contribute to your asthma severity. These factors may include your lifestyle and how you manage your disease. When evaluating asthma severity, consider the following:

• Proper inhaler technique
• Medication adherence
• Access to medical care and treatments, including costs
• Allergen or irritant avoidance
• Good stress management
• Affect of other medical conditions, such as chronic obstructive pulmonary disease (COPD)

Ask your doctor about the long-term outlook for your asthma and any steps you can take to prevent progression or worsening of symptoms.

How should I discuss my asthma severity with my doctor?

Doctors follow national and international asthma guidelines to determine whether your condition is mild, moderate or severe. They also use guidelines to determine the best plan to treat asthma.

Once a treatment plan is formalized, it is important that you take your medications as prescribed. You should also keep track of how they control symptoms. Then report back to your physician on how well the treatment plan is working. Some additional tips to make the most out of your healthcare appointments:

• Determine how often you need follow-up doctor appointments to assess asthma control.
• Work together with your doctor to develop and follow an Asthma Action Plan.
• Keep a daily diary of your asthma symptoms and frequency.
• Keep track of how often you use your medications.
• Be honest about using your medications as prescribed.
• Make a list of questions or concerns you want addressed.
• Ask about new and advanced treatments (biologics) that treat severe asthma.

If you do not understand the terms your doctor is using and what they mean, ask for an explanation.

While asthma is a chronic condition, some people may experience periods of better control, especially with changes in treatment. Discuss whether any changes you make could improve long-term outcomes. Remember: anyone can have a severe or life-threatening asthma flare-up. That’s why it is important to develop an asthma medication and treatment plan that is right for you. Then learn ways to improve your asthma management.