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What Are The 4 Categories of Asthma?

The four main categories of asthma, a chronic respiratory disease that makes it difficult to breathe, are intermittent, mild persistent, moderate persistent, and severe persistent.
The four main categories of asthma, a chronic respiratory disease that makes it difficult to breathe, are intermittent, mild persistent, moderate persistent, and severe persistent.

Asthma is a chronic respiratory disease that causes inflammation and narrowing of the airways, making it difficult to breathe. 

There are four main categories of asthma based on severity, as classified by the National Asthma Education and Prevention Program:

  • Intermittent
    • Symptoms are mild and do not interfere with normal activities
    • Symptoms occur less than twice a week
    • Nighttime symptoms occur less than twice a month
    • Asthma attacks are infrequent
    • Lung function tests are normal when a person is not having an asthma attack
  • Mild persistent
    • Symptoms occur three to six times a week
    • Nighttime symptoms occur three to four times a month
    • Asthma attacks affect daily activities
    • Lung function tests are normal when a person is not having an asthma attack
  • Moderate persistent
    • Symptoms occur daily
    • Symptoms interfere with normal activities
    • Nighttime symptoms more than once per week but not every day
    • Asthma attacks affect daily activities
    • Lung function tests are abnormal 
  • Severe persistent
    • Symptoms occur throughout the day, every day, and severely limit daily activities 
    • Nighttime symptoms occur frequently, sometimes every night
    • Lung function tests are abnormal 

Asthma can also be classified by whether it is allergic or non-allergic: 

  • Allergic asthma is triggered by exposure to an allergen, such as pollen or pet dander
  • Non-allergic asthma is triggered by factors such as stress, illness, extreme weather, irritants in the air, and some medications

There are also numerous types of asthma, including:

What Are Symptoms of Asthma?

Symptoms of asthma include:

  • Difficulty breathing
  • Shortness of breath
  • Wheezing 
  • Chest tightness
  • Coughing, especially at night or early morning, during exercise, or when laughing

Asthma symptoms may:

  • Come and go over time 
  • Start or worsen with viral infections, such as a cold
  • Worsen at in the morning or at night

Asthma attacks refer to episodes of significantly worsening symptoms that require a change in usual treatment. Asthma attacks may come on either gradually or suddenly and can be life-threatening. 

What Causes Asthma?

The cause of asthma is unknown, but it usually results from a strong immune system response to a substance in the lungs.

Common triggers for asthma symptoms include: 

  • Allergies (such as pollen, ragweed, dust mites, mold, or animal dander)
  • Irritants in the air (such as smoke, strong odors, chemical fumes) 
  • Extreme weather conditions
  • Cold air
  • Exercise
  • Illness, particularly respiratory illness or the flu 
  • Stress
  • Panic 
  • Strong emotions that can affect normal breathing patterns, such as laughing, crying, or shouting
  • Certain medications
  • Some foods

How Is Asthma Diagnosed?

Asthma is diagnosed with a patient history and a physical exam, which includes the doctor listening to a patient’s breathing and checking for allergic skin conditions. 

Tests used to help diagnose asthma or rule out other causes for symptoms include: 

  • Pulmonary function tests
    • Spirometry    
    • Bronchoprovocation tests    
    • Peak expiratory flow (PEF)    
    • Fractional exhaled nitric oxide (FeNO) tests    
    • Provocation (trigger) tests
      • Exercise challenge
      • Irritant challenge
      • Methacholine challenge
  • Allergy skin or blood tests, in patients who have a history of allergies

Diagnosing asthma in children younger than 6 can be difficult, since young children are usually unable to perform a pulmonary function test such as spirometry. Asthma medicines may be tried for a few months to see how the child responds.

What Is the Treatment for Asthma?

Asthma is usually treated with quick-relief and long-term control medicines. Allergy shots (immunotherapy) may also be helpful.

Quick-relief medications are bronchodilators that expand the airways, and are taken at the first sign of asthma symptoms for immediate relief:

  • Short-acting inhaled beta2-agonists (inhalers)
  • Anticholinergics

Long-term asthma control medications are taken daily to prevent symptoms and asthma attacks and include:

In severe cases, when traditional treatments do not work well enough other therapies may be used, such as:

  • Biologics
    • Benralizumab (Fasenra)
    • Dupilumab (Dupixent)
    • Mepolizumab (Nucala)
    • Omalizumab (Xolair)
    • Reslizumab (Cinqair)
  • Oral corticosteroids
  • Immunotherapy, useful when asthma is triggered by an allergy
    • Allergy shots (subcutaneous immunotherapy [SCIT])
    • Sublingual (under the tongue) tablets or drops (sublingual immunotherapy [SLIT])

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References
https://acaai.org/asthma

https://www.nhlbi.nih.gov/health-topics/asthma

https://www.healthdirect.gov.au/complications-of-asthma

https://www.nhlbi.nih.gov/health-topics/asthma