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Asthma Severity: Don’t be a Cheese Danish!

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When a doctor evaluates a patient for asthma, one of the primary goals is to establish the severity of the asthma.  The more severe the asthma, the more intensive the medication regimen is likely to be.

Asthma severity is classified as:

  • Intermittent: this is the mildest form and the airway lining is so thin, it’s invisible to the naked eye (no picture of this one!)
  • Mild persistent: the onion ring represents the cross section of a small airway of the lungs with swelling (inflammation) of the lining of the airway, but no constriction (narrowing) of the lumen of the airway.
  • Moderate persistent:  the chocolate donut represents the cross section of a more inflamed airway with narrowing of the lumen of the airway.
  • Severe persistent:  the bagel represents significant swelling/inflammation of the walls of the small airway with substantial narrowing of the airway.
  • Fatal asthma:  the Cheese Danish represents the findings of an airway in a person who died of asthma with the lumen of the airway filled with mucus and debris.  No air is flowing through there!

Asthma severity depends on the following factors:

  • Day time symptoms: asthma symptoms more than 2 days per week suggest mild persistent asthma and the need for a daily controller medication.  Symptoms throughout the day is “severe asthma”
  • Night time awakening:  If you awake more than twice a month due to asthma, that is too much.  If awakenings are occurring more than once a week (but not every night), that is moderate persistent asthma.  For children less than 5 years old, ANY night awakening suggests persistent asthma and needs a daily controller medication.
  • Albuterol use:  If a person is needing to use albuterol (quick relief rescue medication) more than twice a week during the day, they have mild persistent asthma.  If use is daily, that is classified as moderate persistent asthma.  If a person is just using albuterol BEFORE exercise to prevent symptoms, this does not count against you!
  • Lung Function test (spirometry):  if your spirometry level is not normal you already have moderate persistent asthma.   Patients with mild persistent asthma can have normal lung function. Children under 5 years of age, are unable to perform spirometry reliably, so this measure is not used.
  • Interference with normal activities:  if there is minor limitation of normal activities, then this suggests mild persistent asthma.  If you are extremely limited, this is severe persistent asthma.
  • Asthma Questionnaires:  There are several validated brief questionnaires available that with a handful of questions can determine if asthma is controlled.  I like to use the Asthma Control Test (ACT), but there is also the ATAQ (Asthma Therapy Assessment Questionnaire) and the ACQ (Asthma Control Questionnaire).

To read the NHLBI National Guidelines on the Diagnosis and Treatment of Asthma go to:

At Family Allergy & Asthma Care of Montana, we specialize in classifying asthma severity in order to develop the right asthma plan for you!

This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.  


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