Updated 04 September 2018

How severe is your asthma?

Asthma severity is assessed to decide which treatment is suitable. Grade one is the mildest grade (known as mild intermittent asthma) and grade four the most severe.


Since a doctor will initiate treatment based on the severity of your asthma at diagnosis, they 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).

Attacks typically episodic

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.

The assessment of severity is used as a starting point to assign a child to a particular treatment group. This assessment 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 one is the mildest grade (known as mild intermittent asthma) and grade four the most severe. Grades two, three and four are classified as chronic or persistent asthma. The doctor will assign you to the most severe grade in which any feature occurs.

Reviewed and updated by Prof Eugene Weinberg, Paediatrician Health24. April 2015

Image credit: iStock


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Professor Keertan Dheda has received of several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others.Read his full biography at the University of Cape Town Lung Institute

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