Everything You Need to Know About Asthma Classification

More than 25 million Americans suffer from asthma.

Though it is a chronic condition, proper care and treatment can help manage asthma and its symptoms in the long term. 

Not everyone experiences asthma in the same way.

Depending on how often you experience symptoms, and how severe those symptoms are, your asthma may have a different classification.

Understanding the severity of your asthma and your classification will help your doctor or healthcare provider design your medication and treatment plan.

Even when they know the severity of your symptoms, the classification of your asthma symptoms may change over time.

And any person with asthma can have an asthma attack, regardless of their classification.

In this article, I’ll explain the differences between the four main asthma classifications.

I’ll also cover when to reach out to your doctor or healthcare provider for more information and personalized treatment.

Intermittent Asthma

Intermittent asthma is one of two classifications of mild asthma. Mild asthma patients make up the largest proportion of total asthma patients.

In a study of more than 150,000 people with asthma, 67.1% experienced mild asthma, 25.5% experienced moderate asthma, and 7.4% experienced severe asthma. 

Symptoms

Intermittent asthma is defined as having the following daytime symptoms less than twice per week:

• Cough
• Chest tightness
• Wheezing
• Difficulty breathing

Additional characteristics include:

• Use of albuterol (or other short-acting beta 2-agonists (SABA)) inhaler less than twice per week
• Normal lung function tests, including forced expiratory volume in one second (FEV₁), between exacerbations
• Awakened by nighttime symptoms less than twice per month
• No symptoms between attacks
• Exacerbation of asthma requiring oral corticosteroids 0-1 times per year

Treatment

Short-acting beta 2-agonists (SABAs) inhalers can work within five minutes to relieve symptoms for a period of 3-6 hours.

SABA inhalers, also called rescue inhalers, provide relief by reducing airway narrowing and other symptoms, including cough, chest tightness, and wheezing.

When used to treat mild intermittent asthma, SABAs should be used as-needed and at the lowest dosage recommended by your provider. 

Risk factors

Although experts haven’t identified the exact cause of asthma, we do know that certain factors can put an individual at higher risk of developing any type of asthma.

These factors include:

• A family history of asthma
• Regular exposure to certain environmental factors, including air pollution, gases, fumes, and allergens
• Seasonal or food allergies
• A history of viral infections, including influenza, common cold, bronchitis, or COVID-19

Mild Persistent Asthma

Symptoms

Mild persistent asthma is defined as having the following daytime symptoms more than twice a week, but not daily:

• Cough
• Chest tightness
• Wheezing
• Difficulty breathing

Additional characteristics include:

• Awakened by symptoms at night that happen between 3-4 times a month, but less than weekly
• Daytime use of albuterol inhaler more than twice per week, but not every day
• Symptoms that interfere slightly with normal activity
• No symptoms between attacks
• Having normal lung function tests, including peak expiratory flow (PEF), between attacks
• Two or more exacerbations per year requiring oral corticosteroids 

Treatment

Your provider may prescribe a combination inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) for the treatment of mild persistent asthma.

This medication can help reduce symptoms, improve lung function, and decrease the frequency and severity of attacks.

Follow the instructions laid out by your provider when using ICSs.

They are generally used daily.

Risk factors

The same factors can put an individual at higher risk of developing any type of asthma:

• A family history of asthma
• Regular exposure to certain environmental factors, including air pollution, gases, fumes, and allergens
• Seasonal or food allergies
• A history of viral infections, including influenza, common cold, bronchitis, or COVID-19

Moderate Persistent Asthma

People with moderate persistent asthma experience symptoms daily. 

Symptoms

Without treatment, people with moderate persistent asthma experience the following symptoms every day:

• Cough
• Chest tightness
• Wheezing
• Difficulty breathing

Additional characteristics include:

• Awakened by symptoms at night more than once a week, but not every day 
• Symptoms that interfere with daily activities
• Abnormal lung function tests, specifically tests that are more than 60% but less than 80% of expected values
• Peak expiratory flow (PEF) that varies by more than 30% throughout the day
• Exacerbations of asthma requiring oral corticosteroids more than twice per year

Treatment

To treat moderate persistent asthma, your provider may recommend a higher dose of an ICS or a combination inhaler containing ICS and LABA.

This treatment has been shown to reduce exacerbations and hospitalizations. Your doctor or provider will work with you to create a treatment plan that is best for you, taking into account your medical history, environmental exposures, and treatments tried in the past.  

Risk factors

The same factors can put an individual at higher risk of developing any type of asthma:

• A family history of asthma
• Regular exposure to certain environmental factors, including air pollution, gases, fumes, and allergens
• Seasonal or food allergies
• A history of viral infections, including influenza, common cold, bronchitis, or COVID-19

Severe Persistent Asthma

People with severe persistent asthma experience symptoms throughout the day.

Symptoms

Additional characteristics of severe persistent asthma include:

• Awakened at night by symptoms more than once a week, sometimes every night 
• Symptoms that significantly interfere with daily activities
• Abnormal lung function tests, specifically tests that are 60% or less than expected values
• Exacerbations of asthma requiring oral corticosteroids more than twice per year

Treatment

Treatment of severe persistent asthma may involve some trial and error when it comes to finding the right dosages and combinations of medications.

Working closely with your healthcare provider is the best way to stay on top of your asthma care.

Depending on individual factors, medications you and your provider may try include:

• ICSs or combination ICS/LABA
• Oral corticosteroids
• SABAs
• Leukotriene receptor antagonists
• Other medications used to treat the underlying cause or trigger of your asthma symptoms

Risk factors

The same factors can put an individual at higher risk of developing any type of asthma:

• A family history of asthma
• Regular exposure to certain environmental factors, including air pollution, gases, fumes, and allergens
• Seasonal or food allergies
• A history of viral infections, including influenza, common cold, bronchitis, or COVID-19

When to See a Doctor

If you’re experiencing symptoms of asthma, talk to your doctor.

They will work with you to identify which asthma classification you may have.

Once the classification is determined, work with your provider on an ongoing basis to maintain an optimal treatment plan.  

How K Health Can Help

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