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Since a doctor will initiate treatment based on the severity of your asthma at diagnosis, he will assess and classify the severity of your asthma according to the latest guidelines for the management of asthma in adults and adolescents (2007), or the latest guidelines for children (2009).
Asthma severity is assessed only at the first consultation to decide which initial treatment to start, but after this the doctor will use a similar system (see below) to assess asthma control in order to guide decisions to either maintain or adjust therapy, i.e. to step it up if necessary, or down if possible.
Asthma severity
The assessment of severity is used as a starting point to assign a child to a particular treatment group. The assessment of severity is performed between acute episodes in a patient who is not receiving long-term therapy. Assessment of severity depends on the frequency of symptoms and the peak flow reading obtained (the latter in children five years and older). Symptoms are divided into day- and night-time symptoms (essentially cough and wheeze). Asthma attacks are typically episodic. The intervals between the attacks may be days, months or even years. For severe asthmatics, however, attacks can take place on a daily basis. Grade 1 is the mildest grade (known as mild intermittent asthma) and grade 4 the most severe. Grades 2, 3 and 4 are classified as chronic or persistent asthma. The doctor will assign you to the most severe grade in which any feature occurs.
Table 1: Classification of severity of asthma in adults and adolescents
Grading | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
Name | Intermittent, Mild | Chronic/persistent, Mild | Chronic/persistent, Moderate | Chronic/persistent, Severe |
Daytime symptoms: any cough, tight chest and wheeze | 2 times per week or less | 3-4 times per week | More than 4 times per week | Continuous |
Nighttime symptoms:any cough, tight chest, wheeze and night waking | Once a month or less | 2-4 times per month | More than 4 times per month | Frequent |
Peak flow while exhaling | 80% or more of your maximum | 80% or more of your maximum | Between 60 and 80% of your maximum | Less than 60% of your maximum |
Table 2: Classification of severity of asthma in children
Grading | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
Name | Intermittent, Mild | Chronic/persistent, Mild | Chronic/persistent, Moderate | Chronic/persistent, Severe |
Daytime symptoms: any cough, tight chest and wheeze | 2 times per week or less | More than twice a week, but not daily | Daily | Continuous |
Nighttime symptoms:any cough, tight chest, wheeze and night waking | Once a month or less | 2-4 times per month | More than once per week, but not nightly | Frequent |
Peak flow while exhaling | 80% or more of the child’s predicted best | 80% or more of the child’s predicted best | Between 60 and 80% of the child’s predicted best | Less than 60% of the child’s predicted best |
Reviewed and updated May 2011 by Dr Mike Levin, pediatrician at Red Cross Children's Hospital, Cape Town.
National Asthma Education Programme (NAEP)
Allergy Society of South Africa (ALLSA)
