Asthma Management: Classifications

Table of Contents

Asthma severity is classified into one of the following four categories:

1) mild intermittent,
2) mild persistent,
3) moderate persistent, and
4) severe persistent.

TABLE 1 outlines this classification. Patients who experience asthma symptoms more often than two days per week or two nights per month are classified as having “persistent” asthma, and should be recommended for ongoing therapy with long-term control medications. Because a variety of symptoms are listed in each category, patients should be classified in the group that corresponds to the most severe of their symptoms. Moderate to severe exacerbations can occur in any of the four categories.

Table 1. Asthma Classification by Severity

Mild Intermittent

Symptoms occur <2 times per week

Exacerbations are brief, ranging from a few hours to a few days

Nighttime symptoms occur <2 times per month

PEF is normal between exacerbations and patient is asymptomatic

FEV₁ or PEF > 80% predicted

PEF variability < 20%

Mild Persistent

Symptoms occur >2 times per week

Exacerbations can affect patient’s activity

Nighttime symptoms >2 times per month

FEV₁ or PEF > 80% predicted

PEF variability 20%-30%

Moderate Persistent

Symptoms occur daily

Exacerbations affect patient’s activity

Exacerbations occur 2 times a week or more and can last for days

Nighttime symptoms >1 time a week

FEV₁ or PEF >60% – <80% predicted

PEF variability >30%

Severe Persistent

Symptoms are continuous

Physical activity is constricted

Exacerbations occur frequently

Nighttime symptoms occur frequently

FEV₁ or PEF <60% predicted

PEF variability >30%

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