Asthma Classification and Management

Classification by Severity

The American Academy of Allergy, Asthma, and Immunology recommends classifying asthma severity into four categories: intermittent, mild persistent, moderate persistent, and severe persistent, based on impairment and risk domains 1, 2, 3.
Asthma severity classification is determined before initiating treatment and guides initial therapy selection, using the most severe category in which any feature occurs across both domains 1, 2, 4.
The four severity categories are defined as follows:

The American College of Allergy, Asthma, and Immunology recommends classifying asthma control into three categories: well controlled, not well controlled, and very poorly controlled, based on symptoms, nighttime awakenings, interference with activity, and lung function 1, 2, 7.
The three control categories are defined as follows:

The National Asthma Education and Prevention Program recommends the following initial treatment approach based on severity:
Ongoing management should be based on control, with the goal of achieving and maintaining well-controlled asthma 1, 6.

The following validated questionnaires can be used to monitor asthma control: Asthma Therapy Assessment Questionnaire (ATAQ), Asthma Control Questionnaire (ACQ), and Asthma Control Test (ACT) 1, 3, 7.

Do not classify severity during acute exacerbations, as this can overestimate baseline severity and lead to overtreatment 4.
Do not rely on symptoms alone without objective lung function testing, as this can lead to misclassification and undertreatment 4.
Do not ignore exacerbation history when lung function appears normal, as patients requiring frequent oral corticosteroids need persistent asthma treatment regardless of FEV₁ 2, 4.
Do not forget age-adjusted FEV₁/FVC norms, as using fixed cutoffs can misclassify older patients 4.
Do not continue using severity classification once treatment begins, as control-based assessment should be used for all treatment decisions 1.
Inhaled corticosteroids are the most effective single long-term controller medication for improving asthma control in both children and adults across all severity levels 1.